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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION` CUSTOMER TO PROVIDE <br /> OWNER NAME \' <br /> ��a�k L `� t Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City, tat�Zip) <br /> -71\ a\ \11 C W (Z-d\ 'MaA\sd eed Restriction;CSM <br /> �l 1 �1 Variance(# ) <br /> HOM PHONE CELL PHONE E-MAIL ADDRESS <br /> Cook Taa'- t (06) c)16-4304 Xlt-F..At YtwAoAjcie @ QQL•C-Ov\ 10' ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> • AGENT NAME \ I CONTRACTOR NAME <br /> bp vGle C �,�� �v`� (kcp c CX? Site Plan including location <br /> AGENT ADDRESS ADDRESS of well/septic <br /> 3\aA v 16W 2a \-,().7)0X 0130aa° . <br /> (City,State Zip) (City,State,Zip) RcSetbacks <br /> V\ \c' ))\) W‘ 83`111 \ a \, 1 &°13 <br /> PHON - Site Pla proval from <br /> (c ) 'aaa. 4-5 -v--1 Co ) c-04,-("mod appl. le township. <br /> E-MAIL ADDRESS \ - E-MAIL ADDRESS \� <br /> )(CV-LW �y12,0V'AVtl1E • g0 .CGY'■ \N.J�.t.C1,QrAvii\ \A•A kc • COO) ..Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLusn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREA : ,,, Elevation of property <br /> El PARCEL ontage drawn to scale. <br /> NUMBER �(C1-Q{��"'��Q 5 Q �' � \ o� g <br /> TOWNSHIP: SECTIO : <br /> 10 w Iv cF -1)k-)AA) 1/: Iv.W 1/41/4: N .,E Drivew permits <br /> ADDRESS: \ (state ounty,town) <br /> -61a\ \I€W CJ� V"`cAdi l c-zio \41 t3 5 1 I Sanitary aermits <br /> CSM: L LOT SUBDIVISION BLOCK/LOT <br /> 'S-1 .-. 2.. private) <br /> PROPOSED PROJECT INFORMATION „;:. Acv: <br /> PROJECT DESCRIPTION: s <br /> k This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. ,x ,, 7, <br /> SANITARY SERVICE: s Y , <br /> PERMIT NUMBER: �®�a� } ���� <br /> SEWER ❑SEPTIC tg ���i a x a -, <br /> HEIGHT IN FEET: ':::,-:,:72: � ' �� <br /> _� NUMBER OF STORIES: (Not including basement) ,� '�� � -r � �� <br /> t- \ a . iyfla a� I1 <br /> "gym ri I , <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) : .5 :Ei <br /> BASEMENT: 1ST FLOOR: <br /> _ ® �� <br /> A)E 0000 TOTAL SQUARE FOOTAGE: �, Rmi' � ' n <br /> 2ND FLOOR: 3RD FLOOR: . <br /> ESTIMATED CONSTRUCTION COST: _, h� <br /> (Please round to nearest dollar) -* . "* "+ $ 16 �j�j 6 II% .�� <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 LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 14Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 1/Yes 4 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) DYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes E"No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -r -0. <br />