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• <br /> SUPPLEMENT io_Web App t# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> *ROPERTY OWNERINFORMATION?__ ` <br /> -,... �=a., _..;-�-.:.Nii �-�;,t1.,. CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> )E (A.)lop€,r V V-"t Zo Status; CUP; <br /> / OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> / I( ? -Ste sr 4 is t, Variance(# ) <br /> VVV HOME PHONE CELL PHONE E-MAIL <br /> ADDRESS / /) <br /> � o l V&9 7/7 ,}-w,ppe✓iyr y6J Co <br /> o �/Co / 7 Ian drawn to scale <br /> _AGENT-INFORMATION . ` CONTItAC'[OR INFORMATION .� ,- and includes dimensions <br /> r F.� <br /> 'AGENT NAME CONTRACTOR NAME <br /> ✓ve15p1 ELL.' e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> • <br /> (City,State,Zip) (City,State,Zip) S acks <br /> PHONE PHONE Plan a royal from <br /> • (LCD'-'5 7Ce,—"Co&0 applic township. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> F or plans to scale <br /> PROPERTY/LOCATION INFORMATION htt //aecessdane co danew�us stn <br /> ( P N El ation of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE _ <br /> ❑ <br /> PARCEL �°� outage drawn to scale. <br /> NUMBER C)� 11""' 1 a -•A./3G—O I <br /> TOWNSHIP: SECTION: <br /> Qr.64-8 %4: %%4: ❑D ' mits <br /> ADDRESS: J (s ,cou ,town) <br /> 1 Get £Ske,- -kc I <br /> ❑Sa SUBDIVISION e) <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pubh at <br /> ',p ' ate) njo q <br /> 1 ■ <br /> PROPOSED,PROJECT INFORMATION 5 `' '°g- vre,trREVIEW i t {- <br /> PROJECT DESCRIPTION: ,J s - t .q <br /> �(3\. ekes. �� .a onln District. { ti <br /> .This project is a new building or structure. _ = Mi�'e``s g' 'f <br /> etfnitfec�Use 4 <br /> This project is an addition/alteration to an.existing building or structure. _• ‘ ' <br /> SANITARY SERVICE PERMIT NUMBER r rrec ress, Zf t <br /> y new. Ej:-: <br /> �EwER p EPTIC tom` y r� �... h41 <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) ? r,. _ <br /> L '® , 1 4 d oo <br /> dplali3I <br /> S ?- "aali3m- <br /> ent) <br /> AREA TO NEAREST SQUARE FOOT: - h r l , . t <br /> . <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: „ CO p pmt-,.: <br /> 1 -S0 4.TOTAL SQUARE FOOTAGE ,j ipp st_urbance max,t <br /> •2ND FLOOR 3RD FLOOR �,J ) g't fill t • aCC SS <br /> / • t8`^ :-t-z ter, ^ ,, "r- <br /> . ss mac, <br /> iI elile LLocatlo ?k ' <br /> ESTIMATED CONSTRUCTION COST: <br /> �J� �d�.a�val;3bfe�`ot5t ons <br /> (Please round to nearest dollar) ♦ '� ♦ ♦ ♦ r _ -T " ; : mot;„. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes .rill o ❑Don't know eS <br /> •2. Is there a wetland or floodplain on or near the property? • ❑Yes .0 o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? N es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - i es ❑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) [Yes o KIDon't know <br /> 7. Is this to correct a violation?- :Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(41D8) . <br /> • <br />