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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME C.34 OFFICE'USE L•�/ / 'Q O Fe- //'� <br /> 7 <br /> OWNER ADDRESS (N�um ,Street,City,State,Zip) `t `/ oY Z9nlr g iii6:t <br /> •o� fa. roVG ? a �, <br /> PHONE O& R <br /> E-MAILADDRESS 1 '� �ntlttdt� '? s �/�' <br /> V.Iln G.CoY • .G-rrpJ4c.ii.0-S Z ifA St ii t ! U�, <br /> AGENT INFORMATION CONTRACTOR INFORMATION <br /> AGENT NAME CONTRACTOR NAME ,. Deed Re 7::::lOn CSM <br /> 3 <br /> i' , Variance`,(# <br /> AGENT ADDRESS CONTRACTOR ADDRESS ° <br /> ago z.t � +:,..a t L.. Su.+�. Soo �� .Site flan drawn to scale; <br /> (City,State,Tip) `all-"lrtcit dCa dimensions <br /> (City,State,Zip) t <br /> PHONE 5� 5370'y ?be,-° ' g 441- � <br /> PHONE x ncluding Ioca ion` <br /> X08- aya-7'79 <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS <br /> • it edk»cJe� . - _s. r - l]acICS' ; <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wii.us/) t e <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE ':�x St �z�laRPPr°�! lffo / <br /> PARCEL <br /> LI <br /> s � icab t4 nst11 <br /> NUMBER O T ti i'T oar 90� N- � <br /> ,--1 p <br /> TOWNSHIP: ac-•7 � � ., <br /> /� SECTION: r N '; „��`; a I, ` <br /> .o ■ <br /> /7 /: � E //: NE � „.•,..„:- � < §. <br /> ADDRESS: rta nr/' 15fing <br /> • yi9s V._/0.S - cws- <br /> CSM: LOT SUBDIVISION BLOCK/LOT gt 40c r alns3�Gatt~ �` <br /> PROPOSED PROJECT INFORMATION l oaf o�p� e � ',k <br /> PROJECT DESCRIPTION: r e�-dl” Wdl Oi$1C 1e <br /> /��irhe✓a� ..T Q It �S STrc c�'l�*t3 �.7 [ Sfru tt sv. e� 'IL`j '� a ! <br /> ,This project is a new building or structure. V;1I a.,,, J sawe r �:�} $F0.+ a t o- F . <br /> ❑This project is an addition/alteration to an existing building or structure. k{ M '` <br /> SANITARY SERVICE: �y ` g�l� <br /> PERMIT NUMBER: t, <br /> SEWER ❑SEPTIC . {� <br /> HEIGHT IN FEET � <br /> NUMBER OF STORIES: (Not including basement) ." a <br /> AREA TO NEAREST SQUARE FOOT: <br /> €�rela chm h <br /> I <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,� ' <br /> BASEMENT: 1ST FLOOR: (� lift ¢ Tr/ ErQ51pAItrOtp Rnl <br /> on r , <br /> - ►�_® �ys 4, TOTAL SQUARE FOOTAGE: 1 s o�te �ISt tf aticG;r x R" <br /> 2ND FLOOR: <br /> 3RD FLOOR: A fi(-'41 -�w- <br /> N�A N/: �� � Win ' I � �o <br /> s ReviewLocatl`an et : <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) '� "♦ -0 -+ -► ♦ � arid`a 00-7:4 WO:Z <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ❑No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? Yes ❑No ❑Don't <br /> know <br /> 3. Have you talked with the township about your <br /> project? <br /> 'EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> ❑YesNo <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# <br /> (leave blank if none) <br /> 6. Is a location survey required? <br /> El YesNo ❑Don't know <br /> 7. Is this correcting a violation? ❑YesNo <br /> / 2 i 0 APPLICATION MUST BE SIGNED <br /> sas+iz(troa) (Continue on Back) -+ .-+ - <br />