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t <br /> . ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App# <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Er„c, ' (Acksi 1 'ctsc Zoning Status;CUP; <br /> OWNER ADDRESS (Number,St t,City,State,Zip) Deed Restriction;CSM <br /> Lj 55 1-1.1., RA, M;lik , wi 53�(e.g ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 'acS + '1 ( 7 ; ■ ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION - d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> R400 ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> Sol L.‹... ..-.34...1 Or • <br /> (City,State,Zip) (City,State,Zip) , etbacks <br /> tOeu..l�kc_c. _ t,...)M 535G i <br /> PHONE PHONE to PIa proval from <br /> (OCT - «-045 i ap ' ble township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wLEU.Sa Elevation of property <br /> PARENT PARCEL NUMBER: URRENT ZONING: ACR GE: '"- p p rty <br /> ❑ PARCEL fr ntage drawn to scale. <br /> NUMBER 05(o/osov"'3c��7CCC`.3 �^.1..(E'x <br /> TOWNSHIP: / SECTION <br /> 5 r F7C to( scd 6 1/: ,U) 1/1/: Drivewa rmits <br /> state oun town <br /> ADDRESS: <br /> � � ) <br /> �5o Hf 4 /1 A()ek1°r; �i S-2s4 a <br /> CSM: LOT SUBDNISION BLOCK/LOTSani • • •I'ts <br /> (p • 'c,pnva <br /> PROPOSED PROJECT INFORMATION I € t <br /> PROJECT DESCRIPTION: <br /> . ❑This project is a new building or structure. ` _ `d <br /> f This project is an addition/alteration to an existing building or structure. - <br /> SANITARY SERVICE: PERMIT NUMBER: 4 4 ' s ' <br /> ❑SEWER ®SEPTIC .=a a va- '%, - <br /> HEIGHT IN FEET: NUMBER OF STORIES:, (Not including basement) .,- <br /> AREA TO NEAREST SQUARE FOOT: ,- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ® � � . <br /> TOTAL SQUARE FOOTAGE: �, �" r • -1 � <br /> 2ND FLOOR: 3RD FLOOR: c- .. = { � <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) $ ��) �Q �; : ,� , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑YesNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes _lo LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <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) C=I Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —• <br /> 545-112(4/08) <br />