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ZONING PERMIT APPLICATION www.countyofdane.com =SUPPLEMENT#0Aleb App r# <br /> ;PROPERTY CWNER_INFORMATION' '1 "- c R GUSTO? R TO PROVIDE <br /> 1s its: ning Status; CUP; <br /> OW R�D� N e�r e CV �I . - <br /> eed Restriction; CSM <br /> Variance # ) <br /> HOME PHONE CELL PHONE E-M•IL ADD ESS - • <br /> • at •4111441. O a . J . . . 011 Ci ' . 'e Plan drawn to scale <br /> AGENT:INFORMATION 'CONTRACtORi,INFORMATION_ '-4 . ;_•:._ and incl dimensions <br /> 'AGENT NAME CONTRACTOR NAME <br /> S' Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of We eptic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE i P pproval from <br /> - appli le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> oor plans to scale <br /> .. _ <br /> _PROPERTY/LO__CATION INFORMATION.,:;:-(Ii, ttp//accessdarie eo_dane wi:usn Eleva I• property <br /> P PARCEL NUMBER: CU T NING: ACREAGE . <br /> Q fron -•e • 'wn to scale.n�b 3r 1 1��0 Q / / i.Q <br /> TO IP: SECTION: I��I <br /> e{ Y4: Y4V4; l l Drive ermits• <br /> ADD S: lit/ J <br /> (sta unty,town) <br /> � �� v �` ❑Sanita�, permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> )3s (p a c, .rivate) <br /> PROPOSED PROJECT INFORMATION <br /> __ - .� x FF VIEW } '{ <br /> PROJECT DESCRIPTION: / 4 i ;r .x hr crt g.. <br /> ( a a z-/WI U, W I I zi fcd,(', woo s -:- �g ,,,, .p ' "_ <br /> •f �/ � _ omn Dls�rict <br /> .This project is a new building or structure. /- -?C 11- tra4A-,,,A14-' * <br /> rtaltfec te? . <br /> This project is an addition/alteration to an existing building or structure. ; r, ,: ,;,_ r y <br /> SANITARY SERVICE PERMIT NUMB s Rural Addree ss 4_ V <br /> rEWER EPTIC (new? ,' n• t s <br /> d„,( ___._______] <br /> HEIGHT IN FEET NUMBER OF ST IE (Not including basement) - a; - k..470-_S4:::-.: <br /> i t vvetla •/Floor a�/ <br /> , r <br /> Sho a achment) <br /> AREA TO NEAREST SQUARE FOOT: t -. ,ss �.-,- <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) `( r r� ,_�r� <br /> Erosion _on p-etmlt'W <br /> BASEMENT: 1ST FLOOR ik., •.,� t,� .g <br /> q� 4,TOTAL SQUARE FOOTAGE 4, z��SIOp2S •. rGance=__ _ <br /> 2ND FLOOR: 3RD FLOOR /J 1 f aCC $ �4 <br /> v �gf�evi vir�Loeatlo�= t�!`�-' <br /> ESTINIAT D CONSTRUCTION COST: <br /> tz a- d avllbietl o g' <br /> -t -t -► -► ♦ -� / 0 - r ' 4 - s(Please round to nearest dollar) ` w IF:5-- ; .; ;t t, , <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes DNo DDon't know�. <br /> 2. Is there a wetland or floodplain on or near the property? Dies DNo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - DYes DNo• <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 EiNo ['Don't know <br /> 7. Is this to correct a violation?- DYes al <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► -► <br /> 545-112(4109) . <br />