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' ZONING PERMIT APPLICATION ww .countyofdane.com ;SUPPLEMENT to Web.App#
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<br /> PROPERTY OWNER:INFORMATION., ;;y . . _;,` ,_,- ,1'4.i.i ;': ':',,-//,`,-•-'''' CUSTOMER TO PROVIDE
<br /> OWNER NAME Qom,
<br /> 1 i at^at ' "'� I 5 veN•4 S -v ❑ Zoning Status;
<br /> OWNER ADDRESS umber,Street,City,State,Zip) Deed R C ion;CSM
<br /> �3O3 Arrot.) I^eAci Tvi.,,I par' ce(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> do 3-X35-'-173a Sit Ian drawn to scale
<br /> AGENT INFORMATION - s.. :,. CONTRACTOR;INFORMATION a d includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> V' 40-C—ClivNC,A v\h CAPfvme 1(.411,', Av�� [ov,5iv✓c_-},% Sit Ian including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS ' L-LL of ell/septic
<br /> 9 "g c.rlry L-Q tAe t cr,r-j 1-Av,P .
<br /> (City,State,Zip) (City,State,Zip) etbacks
<br /> co 4 Cam-►vve WT Cs-a7 4- e C—v-ove� vi 52.s-9.7
<br /> PHONE PHONE ❑ Site Plan royal from
<br /> 6,0S--I la-3Sv3- U 60q,- -70-- 16a. o appf le township.
<br /> E-MAIL ADgRESS E-MAIL ADDRESS
<br /> J,„re) A psi ov,ebt.;ld,',.,5 , .- e..4-- c @Caps}w,C toc,,la4-15 ,1,,et— ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wLus/) ❑ Elevation of property
<br /> PARENT PAR NUMB CURRENT ONING: :CREAGE: P P rty
<br /> ❑ NUMBER �� -0�/-.02.�n/' R R' ( ,$3.3-3 frontage drawn to scale.
<br /> TOWNSHIP: SECTI N:
<br /> 13 ❑ Driveway permits
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<br /> (state,county,town
<br /> �'D \ %-1/4:
<br /> ADDRESS: n ( ��town)
<br /> 1, � A\„,5. \N- �''�■∎ 1
<br /> CI Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
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<br /> ' '\ _ (St 4d di (public,private)
<br /> 1 I . vr• , 1 _1�"lX
<br /> PROPOSED PROJECT INFORMATION �,� t.
<br /> PROJECT DESCRIPTION: e 1 , ��.- " ,•
<br /> Tl✓I QM Q`} v�5�17r, V ' V\5 d r e a a @ 3. ,"'
<br /> ❑This project is a new building or structure. �=� ;;
<br /> y)This project is an addition/alteration to an existing building or structure. - , -1-. - ,=-7`
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<br /> SANITARY SERVICE: PERMIT NUMBER: '� 6P' °° ��- :` 4Y
<br /> ❑SEWER LISEPTIC `:' �
<br /> HEIGHT IN FEET aa U v: • • •-I : (Not inclu.ing basement
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<br /> ® *.l "a c
<br /> AREA TO NEAREST SQUARE FOOT: -r
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) " i£ x `
<br /> BASEMENT: 1ST FLOOR: • ®-,. a ,��
<br /> �, TOTAL SQUARE FOOTAGE: 4, �f s ° ,
<br /> ¢�iA �� 'F S.
<br /> 2ND FLOOR: 3RD FLOOR: . - .
<br /> ^u r 3 e .,;
<br /> ESTIMATED CONSTRUCTION COST: ° �,�(Please round to nearest dollar) / 0007 . e y
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li 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. Have you talked 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? Li Yes
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank f none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes pNo
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<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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