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GSUR,1!ErmeNT;#o 11Yeb iiii— <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY'OWNER:INFORMATION: .V ^� K x CUSTOMER TO PROVIDE <br /> OWNER NAME ` <br /> 0/2/X / I9")LF� Zoning Status; CUP; r <br /> OWNER ADDRESS (Number,Street,City,State,Zp)_ 3'7- eed Restriction; CSM <br /> 77/, /c.b05eG,t // -� (%r v y c-t/l 3�� Variance(# ) <br /> HOME PHONE CELL PHONE py E-MAIL A RESS - <br /> • 4(i f� 2 f g7 '% Site Plan drawn to scale <br /> AGENT-:INFORMATION, CONTR/1CTORVINFORMATTION -r ' <br /> ,�,��, �.�r� and includes dimenions ' <br /> 'AGENT NAME CONTRACTOR NAM / <br /> . j?i- 6/& J-cfT _Site Plan including location 0 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5./ J 4I / _ 3 i�50 (V (c" <br /> (City,State,Zp) (City,State,Zip) it Setbacks <br /> f27��f'J ,/ c37/f <br /> PHONE PHONE Site Plan approval from <br /> d - - S7s-- 3 f'6 ,�g applicable township. <br /> E-MAIL ADDRESS E-MAILA °RESS . <br /> `e7 f ri._.' ,e,di . 0,11(z>„. 2 Floor plans to scale <br /> `PROPERTYL <br /> / OCATION INFORMATION (ti ttp I/accessdane co_dane v+ri:us/) ;; <br /> PARENT PARCELL N JMBER: CURRENT ZONING: ACREAGE . /�� Elevation of property <br /> ❑NUMBER 0S- 0�7U 2?>/1J0-7 /2--/ SGT frontage drawn to scale <br /> TOWNSHIP: SEC . (SC ,_ ` �I <br /> v �� %4: N Yv %%4: VV K) Ifs Driveway perm) <br /> ADDRESS; / L /y,� (state,county, Ow ) <br /> Y7/9- /4 `t // ,57---- <br /> / v `mil `, 5- S 3 ❑Sanitary permits <br /> CSM: LOT SU:•VI ON BLOCK/I__OT 0 (public,private) <br /> PROPOSED PROJECT INFORMATION `'`'. sT ° STAFF REV: H/ 7 <br /> PROJECT DESCRIPTION: 4i �' <br /> ? i 7/7/d,/,>-7 N Zoning Dls'tnct itt (� <br /> =te & IZATI . ^k ti4: ; <br /> ❑This project is a �y.- 'n or structure. ya�� � ' <br /> P 1 9 ..5 Permttfbd U`s ?, 10 IA+.Q It...-- <br /> This project is a addition/- eration to an existing building or structure: z `�' � A▪ mow ' <br /> SANITARY SERVICE PERMrr NUMBER rt 9 Rural •• „ _ � <br /> FIEWER EPTIC \ Crl- eXlStirl9 r . 4-.1 rs- <br /> _ ti t <br /> HEIGHT IN FEET NUMBER OF STORIES: of including basemen `F,.,r,, ;, . <br /> • / y 9.e rV�letlar�d/Flo dp3a► % 1 <br /> AREA TO NEAREST SQUARE FOOT :horyeland .(attachment)' , /� <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) , � ti • ,- e <br /> roslo Co of permit' I, / <br /> BASEMENT: 1ST FLOOR <br /> TOTAL SQUARE FOOTAGE • sippes,_1stul lance, -,„: <br /> s2 g- .<-7g-- l l ;� h <br /> fffin actress t P t <br /> _lam: 9 ��� �;.: <br /> 2ND FLOOR 3RD FLOOR p—"Ic �t>a=r•=�-``_Ty. <br /> e..it evi�e nr.�Locatlo TS ey.* i d <br /> ESTIMATED CONSTRUCTION COST: --� --► -�► ♦ ♦ -O. $ )3 D©D. 00 apd aVel�Bb�0t5tIOR5 ..r <br /> (Please round to nearest dollar) •p / • 4;�„t• ^, = <br />