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Its <br /> ZONING PERMIT APPLICATION www.countyofdane.con1 SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> lait OWNER NAME <br /> Y)'1 �Rk Ub �r►'I,A ontng District <br /> OWNER ADDRESS (Number,Street.City,State,Zip) , <br /> 4 A LV I-) P-D-- S u,) , es- E , W i <br /> 535/(3 l Permuted Use <br /> PHONE E-MAILADDRESS <br /> 8 83-)-2-" -7 onin Status,Cl1P; <br /> AGENT INFORMATION CONTRACTOR INFORMATION g <br /> f Deed Restriction,CS[�1 <br /> AGENT NAME CONTRACTOR NAME <br /> Variance t# ) <br /> L'r-/R,s Tr)I� ,re �^'sT- �C ale. <br /> AGENT ADDRESS CONTRALTO ADDRESS <br /> 0fQlar�drawn to scale <br /> ,3l Sly 141 N N G J 1217_ 31�Sla �1^►^'�'/ 20_ and includes dimensions <br /> (City.State.Zip) (City,State,Zip) <br /> �Tr a Gc Gf v�t Li 1 5 35 27 C T ii&( E t w I 5' S 27 ite Plan including location <br /> PHONE PHONE e.g.�fvellJSet <br /> (�6 8� �i 7 (3I, ( S 7 7 )3 (o <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS <br /> 19tbaCkS <br /> PROPERTY/LOCATION INFORMATION (http//accessdane.co.dane.wLus/) plan approval from <br /> PARCEL PARCEL NUMBER: ZONING: J ACREAGE: ppllCa nle`townshlp <br /> NUMBER •5810811- 37-4 .-glgo 5 - 1 , ' 0 S <br /> TOWNSHIP: ^ SECTION: <br /> 5l>.J fl►2�t2t 1�d: 141%. 4,R iralae s� <br /> OW ^4, <br /> ADDRESS: r <br /> mC. s a 6g.. or pian o sc e• <br /> CSM: LOT SUBDIVISION BLOCK/LOT $ a <br /> L� t <br /> - evattOrt of pro as rty <br /> PROPOSED PROJECT INFORMATION frontage drawn tt scale.;, <br /> PROJECT DESCRIPTION: g <br /> Tue..) float a� v�k l.rf '�S�as�.� 2sr�m -F way o ....r.6 VC c l� , i i",„4.4..,wa permits <br /> This project is a new building or structure. (State,County,towr) <br /> U This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: t�ttary a v e <br /> BCV i2rwm, gate <br /> ❑SEWER SEPTIC A.)/A fl'Dp I or/ oo L Za <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> �J � <br /> I (0 1 orelan chment)_ <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) .I' Erosron n r'Ol,permit <br /> BASEMENT 1ST FLOOR: f/ <br /> j TOTAL SQUARE FOOTAGE: j 11"}1Q Pga.. . ,- ' IX-- . <br /> 1_ Illli 1g/ac y <br /> 2ND FLOOR: 3RD FLOOR: ( :: :: <br /> `( S1 <br /> k'� eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -i �) and'avail options <br /> (Please round to nearest dollar) 4� - 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 J No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes 'No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li 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 No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes JNo <br /> ICTIUST B_E SIGNED•(Continue APPLA on ON Back)M <br /> 545-112 11/06) <br />