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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web App`# <br /> :PROPERrf, OWNER;INFORMATION .. _ ' '' ' s x <br /> .__. F::- . . .. � _ _ ,• FICE,USE.OPILY':, . <br /> OWNER NAME \f• 4 tt 1 t _ <br /> TS �OJC- It oning District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> c'N t© _Ci-, c\ - .u A ' ' -t.-vi f • * Permitted Uses <br /> PHONE <br /> � t -MAIL ADDRESS ;( <br /> Jk/O� J f 1, r`.�: + r�n��4 D Do es g slOn Pi <br /> `AGENT INFORMATION �' 'CONTRACTOR,INFORMATIONS .}. ` M * •-Strict, ;.CSM <br /> AGENT NAME c CONTRACTOR NAME . .glance;(# ) <br /> \-ciAc J££.ILA r-.3c,S . <br /> AGENT ADDRESS CONTRACTOR ADDRESS Site Plan,'drawn,t0 Scale ; <br /> c)\tYa (a 6J t- an`d Includes dimensions: <br /> (City,Stale,Zip) (City,State,Zip) <br /> w� 3���� ,❑ Site P1ar ding location <br /> PHONE l PHONE ' ell/septic <br /> E-MAILADDRESS E-MAILADDRESS i:,10.74,3, 2-:f li,064 <br /> 'PROPERTY/LOCATION'INFORMATION?:(httpgl.ac essdanecO:danewi:usn" r:ii - [i Site:Fla royal from <br /> PARENT PARCEL NUMBER: ZONING: dr ACREAGE: a cable township <br /> LI PARCEL /� yn <br /> NUMBER ©lo`°-oa'P _9 '0-3 ^ ,:' <br /> TOWNSHIP: SECTION: 1 Rurat + "r $S <br /> alp •• 1/414: `'- ` a,`(ne eXlstlrt <br /> API. t -0� c fi <br /> DRESS: `` , a y <br /> �a TQ. �v� Te j-t�v h W l �j`���5 � 'w,-3FI aor'pia = ,A` <br /> CSM: LOT U DIVISIO`'JJ BLOCK/LOT ,s a, <br /> �O • S 9 a" �' `� t levatlon.of property -0 <br /> PROPOSED''PROJECT INFORMATION.,,' :i ` „t 4.'; -,, -- ' ; frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> t r , <br /> ll�/ X �v rhea ���rDrivew �� s <br /> . u-This project is a new building or structure. . <br /> county,Mown) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> Q to perm <br /> SANITARY SERVICE: PERMIT NUMBER: ® 'bllc ppvatet <br /> 1J-SEWER s <br /> ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) W tl�nd plain/ sr '' <br /> I Z Sh ditti (attachment) <br /> AREA TO NEAREST SQUARE FOOT: ';0_ ` <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) U ErbsionCOnttre <br /> _ <br /> BASEMENT: 1ST FLOOR: �S700 , eISt- rba 60,, <br /> \� 4, TOTAL SQUARE FOOTAGE: 4, r . pc e <br /> Ing/acres�s) <br /> 3RD FLOOR: '. 3, i` t'rxw t c3 <br /> 2ND FLOOR: �� � - <br /> 100 ❑ Review Lo nSurvey = <br /> ED CONSTRUCTION COST: and a ilab[e options <br /> EST/MAT —� —► —► —► —► -=► <br /> (Please round to nearest dollar) '' """"k "''"5i" "` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes <br /> 4 No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? <br /> ti <br /> ❑Yes 23-No ❑Don't know <br /> 3 Have you talked with the township about your project? 1 Yes CI Nb <br /> 4.. Has there been a zoning permit issued for this property in the past 5 years? 6-Yes ❑No <br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes 111.No ❑Don't know <br /> - 7. Is this correcting a violation? ❑Yes No <br /> s . — <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —'• —► <br />