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ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT toWeb App# . <br /> w <br /> ,PAOPERTY:OWNERINFORMATION ' ' '_: CUSTOMER TO PROVIDE <br /> O E.R.IgM 1 <br /> 1 )t\"-! \- }\ \ Wing Status; CUP; <br /> OWN ADDRESS (Num er, ity,State, ip) <br /> /" O /,), eed Restriction; CSM <br /> \e 1 6 " I C r I-e 5 I Y-) Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • ite Plan drawn to scale <br /> AGENT.INFORMATION• . " • :„ :`CONTRACTOR INFORMATION'`°:-;E `, ,`.. and includes dimensions <br /> ' AGENT NAME ,/ 1 <br /> kU NTRA NAME Y o `�-l_L Q Site P luding location <br /> AGENT ADDRESS CONTRACT R DDR SS of a is <br /> (City,State,Zip) ( ity,State,Zip) tbackS <br /> PHONE P CE j��� � t 'I b ` e Plan approval from <br /> om <br /> pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> or ns to scale <br /> ;PROPERTY/LOCATION INFORMATION htt //accessdane Co lane wi tus ; <br /> PARENT PARCEL NUMBER: CU TZONI G: ACREA E: . ation of property <br /> PARCEL , c+ 3 /� + frontage drawn to scale. <br /> NUMBER C/� Q�Y�a���aX�i r 1 Le <br /> TOWNSHI/P'\ /� SEC ON: .�1 h_' <br /> U V A,•' \ �/4: V- w 1/,/4: N w ❑Dri permits <br /> IADDREA: `J �J J (s , Ounty,town) <br /> CS A) ()r "-� , r ❑Sani permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pub• , nvate) <br /> TAFF'REVIEW <br /> PROJECT DESCRIPTION: / I / = tik <br /> r(` _ j1�Q '/P /�o..,, ^+� s�, Xa'�, otim Dlfstnct fJ <br /> ' hL '� d R.:aS f <br /> ❑This project is a new uilding or structure- `61 r 4. <br /> ���tfed-Use ,x: <br /> [This project is an addition/alteration to an existing building or structure. r , <br /> s 4t .J X.�x ;J: <br /> SANITARY SERVICE: PERMITNUMBEI _ Rur Addr`ess �z 1., <br /> EWER [EPTIC V �� ' w/ 3 •m <br /> HEIGHT IN FEET: ' NUMBER OF STORIES: (Not including basement) = <br /> j / t -d/F dpla n/ - <br /> r Si " d°(attachment) <br /> AREA TO NEAREST SQUARE FOOT . z - <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) z `- ,, ' <br /> Erosion• •ntrol permit' ... <br /> BASEMENT: 1ST FLOOD x3--r A w'g <br /> I ,', TOTAL SQUARE FOOTAGE: j, slopes •.I' • Ce <br /> filfl`Fe's- -ma y . <br /> / 2ND FLOOR 3RD FLO01-7 <br /> R ��1 ; �� G `yr <br /> �i/ f3 ;, sr' i rz s�, r <br /> vie , catiorm SUrvey <br /> !. A 1., l' tea.511V1 7 <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ -+ '♦ --► '♦ '♦ 0 op 6 0 and Zi ab 1 options {sue <br /> � � s-ie �a.^�`�..yirrr{._ .tom a tj-�6: <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes .):210 [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Io [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement?---- [Yes <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - [Yes j20o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) Dies J.-.)/ [Don't know <br /> 7. Is this to correct a violation? [Yes .r N io <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —I• -3 —► <br /> 545-112(4/D8) - . <br />