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SUPPLEMENT ii 1Neb App.ik <br /> ZONING PERMIT APPLICATION www.counryofdane.com WAIIIIIIII <br /> 1ROPERTY O WNER INFORMATION r ''`` r�., .,.= Cu•TOMER TO PROVIDE <br /> ovt6FR NAME) <br /> at/ e I n S 5 W Zoning Status; CUP; <br /> OWNER ADDRESS (Nu a Street, i tate,Zp .�`.3,�`.-z7 ed Restriction; CSM <br /> ate/ lo' 4 41:4 SP vorrP � ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL S <br /> 405---5--/Z -5 60o�0?i/f Ay,413'4411 4'' °"7 S'e Plan drawn to scale <br /> AGENT INFORMATION, , ' CONTRACTOR INFORMATION T <br /> a� � <br /> d includes dimensions <br /> " AGENT NA1E CONTRACTOR NAME <br /> o —le <br /> /LS - 5" I�e ytt lc�t" Lcs mite Plan including location <br /> AGENT DDRESSA a'n n ^ co Fj�AsC- Ala le j of well/septic <br /> / L/o/J� y� I�`J-�/J ` G,ii <br /> (Cittyyt�Sta e, p) / (City,State,/yip) Setbacks <br /> Li se o w pD Ce l- ,?.5-/ Al,ci i -(7,/ /vx- 5371,E <br /> PHONE PHONE ❑ ite Plan royal from <br /> 602-�5-5-"'- 7—z-3 ddb -75—/4,4i/ applic etownship. <br /> E-MAIL ADD ESS // E-MAIL ADDRESS • <br /> G>'1�v5/4 i r AVS Oil/� - Floor plans to scale <br /> ,PROPERTY/LOCATION:INFORMATION (httodiaccessdarie co iiane i i <br /> - E Elevation of property <br /> PARENT PARCEL NUMBER: C�RENT Z ING: ACREAGE <br /> ❑PARCEL Z (I ^ a� (� ,\ ( fS.ontage drawn to scale. <br /> NUMBER �1 `lJ 1 <br /> TOWNSHIP:[ SE TIONt� E...--.2. 1 1 / <br /> 3u 4 /'"� t ri+° c7C /: '/a%4: Y v RI Driveway permits <br /> ADDRESS: J tate,county,town) <br /> '7670 /.ti z.vay <br /> Sanitary permits <br /> CSM: LOT ` SUBDIVI ION/ BLCDC-KA_OT (public private) t <br /> p,, ,Nicky- <br /> PROPOSED PROJECT INFORMATION 4 7f STAFF IEW z . <br /> PROJECT DES,C TION: / J -- r ?r _ e K V& <br /> ./''1/j, ' �L:►�Gi° -.-r `/ lC, c % 'K c ' onmg Distnct rl <br /> x <br /> . ❑This project is a new building or structure. i f, r _ r C <br /> Permitted Use / <br /> ❑This project is an addition/alteration to an existing building or structure. - � " :4 . r <br /> .+ > N: <br /> SANITARY SERVICE: PERM NUMB R: ® Ur I Address n <br /> EWER EPTIC 1 O ' ^ OO a/existing) - Pr.,l \)1,/ ± <br /> HEIGHT IN FEET t NUMBER OF STORIES: (Not including basement) ® f %,a <br /> J Wetland/Floodpjai n/ <br /> • S retafid (a�tac ent) <br /> AREA TO NEAREST SQUARE FOOT =r ' s , 4 <br /> •(Outside dimensions including unfinished area,attached garages and above grade decks or porches) - r = <br /> BASEM NT 1ST FLOOR: rosionCQnfrol emit <br /> -• -•-•L�.�cR c L/0 -,,,t4....26,...471, 9 /O 4, TOTAL SQUARE FOOTAGE , ,slopes lstu an„e <br /> V / 1�s f Ir ccess� o5 I' <br /> 2ND FLOOR: 3RD FLOOR: .A3 5y'I My) tE r I t y. } <br /> Y 7 1- �y Sgcg^� �' �r r <br /> FZev_iew�L}ocatior�Silrvey <br /> OCR a }- t lsrn <br /> ESTIMATED CONSTRUCTION COST -and aval O o tions* <br /> (Please round to nearest dollar) 4 _„ ,� 5 , z r K _:, <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - ❑Yes No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le a blank if one) <br /> 6. Is a location survey required? (see reverse) es o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4ro8) \'(�jf`Tyj . 0 (Continue on Back) ■ -► -► <br />