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r <br /> ZONING PERMIT APPLICATION www.countyofdane.com -SUPPLEMENT-to;Web.App#: <br /> PROPERTY OWNER.INFORMATION - ' : ": <br /> ERwue ' CUSTOMER TO PROVIDE <br /> oIl0..k *0•■.,\.s Gl.,e IAA _ <br /> ❑ Zoning Status;CUP; <br /> UP•ows=RAOORESS Street .s .no <br /> Restriction;csM s 4/4I Ka.)est C7tt5' Ula.w,0.keC) tts. �3�97 Variance(# <br /> 1 )SE E <br /> i � 4 i 0 E-MIVLADDRESS <br /> Site Plan drawn to scale <br /> AGENT TIINFOR/M�ATION �_ J ;)CONTRACTOR-INFORMATION.. and indudes dimensions <br /> Zn/ 3. a 1 h t'e4.h/i CONTRACTOR NAME <br /> ❑ Site Plan Including location <br /> ADDRESS n CONTRACTOR ADDRESS well/septic Lo, e P.rte.-�r of wrelUse tic <br /> (City,stare,Zip) (CKY.State,ZIP) ❑ Setbacks <br /> $.crZe_v tioo WI. S.-SS-07 • <br /> ,�o Q 9 ,J ❑ Site Plan approval from <br /> to 7 cA 6 applicable township: <br /> /�,h,nn <br /> E-MAIL ADDRESS <br /> I v = 1009 o90 9'7 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION. (httpa/accessdane co danewe.usl) {; <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE ❑ Elevation of property <br /> ❑ dsio Oho t'j$1((j 9 .L C-/ / 2 '7•S-' frontage drawn to scale. <br /> TOE W SECTIOPk <br /> Qg Si e, ,. V t4.tr71 g.- /: SE '/,'h: fuE• ❑ Driveway permits <br /> / (state,county,town) <br /> '$/4! Ko.Ie tl 7t& Wtc�r.ate.t~ 6VL.���97 ❑ Sanitary permits <br /> oN DoT (public,private) <br /> s <br /> PROPOSED PROJECT INFORMATION 1:-.--:-:-'..-:::,._=:::,;7‘:.c•"..-, -a . <br /> ,� <br /> PRO.1ECTOnoN: <br /> 1toX$©o►L1 + <br /> o is <br /> rt � It �ar �5 . mg rstkrt;f° ` �-- _ <br /> ❑This project is a new but1ding or structure. ' ' } `1�' <br /> ❑This project is an addition/alteration to an existing building � - ',4';7-,-,.-i.1',•!---1:1. <br /> g ing or structure. °� _ � �' <br /> SANITARY SERVICE: PERMIT NUMBER: .❑.= afai=Addre� s` <br /> ®SEWER ❑sEr- / S�9)" £ ` `4 <br /> FIGHT BI FEET` NUMBER OF STORIES: (Not Including basement) '- �.'T-' - �3 .- + -� <br /> ii C f' / ❑ Wetiand/Fioodplarn1.'04 �> <br /> AREA TO NEAREST SQUARE FOOT: �4'hC�rela �attaE_Imellt); <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches ` ` - : _ - <br /> BAsEMENT: 1STFLOOrt } rgsronControl permit, <br /> //8't4 S . `J 4.TOTAL SQUARE FOOTAGE: 4 ,A(slpp d stt.tr 3ance; . <br /> Q%J . ' _ 3 r <br /> V1 - -� ., <br /> 2ND FLOOR: 3RD FLOOf;w fil recess - <br /> j/ B � '� "� <br /> ESTIMATED CONSTRUCTION CAST © Review Loca n St rvey <br /> (Please round to nearest dollar) -► -► -► -d. -s -► $ �U 00 a[3d vatiabTe options <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ( No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Halve you tatced with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1 No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No ❑Don`t know <br /> T. Is this to correct a violation? ❑Yes OW <br /> APPLICATION MUST BE SIGNED <br /> 545-112 Nei O•/ 3 (Continue on Back) -► -o• --o• <br />