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76. 23 <br /> :,SUP,PLEMEN..#o`w„b App r#r <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> 70ROPERTY;OWNER:INFORMATION' r x1'u p CUSTOMER TO PROVIDE <br /> N i1AMi OWNS j� <br /> E 1 A� U V IZ fst P- n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Sg•reet,City,State,Zip) Deed Restriction; CSM <br /> 2.°(5 v�No�� �� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS • - <br /> 6o8 83'' X18 • (1/ lift 4-)6 s±er e hat"mo.,!• f <br /> Site Plan drawn to scale <br /> tea- •_ <br /> AGENT_INFORMATION, 3: CONTItAC OR�'IN'FORMAT,ION_-� �_ and includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME <br /> . ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,Stale,Zip) (City,State,Zip) n Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> n Floor plans to scale <br /> :PROPERTY!LOCATION INFORMATION (httP l/accessdalpe co:dane w us/Jt V lf <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE <br /> Elevation of property <br /> PARCEL V 7 ' - 142_-1.5D0 -7 frontage drawn to sca <br /> le. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • <br /> 1/4. //4. n Driveway permits <br /> ADDRESS J (state, county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> • <br /> PROPOSED_PROJECT INFORMATION x ' TikKe IttitIEW ry r- <br /> PROJECT DESCRIPTION: �se. t �a> x , • G .,€ <br /> r L, s tx <br /> 9 -1-Ac}tt7 D A 5Sf+cs rL1t! /5�-r 6 , C� Zoning District r <br /> This project is a new building or structure. Peimlttet Uses n <br /> This project is an addition/alteration to an existing building or structure. ;* ?4 yY <br /> SANITARY SERVICE PERMIT NUMBER "� Rural Address, A _ <br /> FIEWER [�EPTIC 1r (ew7�2xlsti g) '_ °, f,l . <br /> HEIGHT IN F/EETT �i J NUMBER OF STORIES: (Not including basement) y�r <br /> 1 V `l� /1.A ®rearm' <br /> etland/Floodal�n:/,.erg:, <br /> C � $h oreland`'(attaclTment) <br /> AREA TO NEAREST SQUARE FOOT "4-f 9 4 '=. <br /> . (Outside dimensions including unfinished area attached garages and above grade decks or porches) Y5-ii -•. r - <br /> 0 EroslonCo_ntrol permit <br /> BASEMENT: 1ST FLOOR ' ' �+ <br /> '1 o S r 4,TOTAL SQUARE FOOTAGE: ,j, ' Etslbpes disturbance ,P , <br /> L bad fili -g ce s} , -, <br /> _F <br /> 2ND FLOOR 3RD FLOOR 1 L--. 0O • ?--t-,--;44_ .- r', 0. �"_`,_'•l;aevl w"'LoeatlarfrSti y=. <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ _ and valabfe t ons..>`'±a�•;I <br /> (Please round to nearest dollar) I ;>^• ` - f t=_°. r_,' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes [Eglo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - aes —`k o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) . <br /> • <br /> 6. Is a location survey required? (see reverse) f Yes .jam o QDon't know <br /> 7. Is this to correct a violation?- DYes Sr o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ —► —P <br /> 545-112(4/08) - <br /> • <br />