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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / £iF4(.S RN*Id ✓. 13144 / c/I4 GRFF.c/ I4C ❑ Zoning Status' , <br /> OWNER ADDRESS (Number,Street,City,State,Zip) r, Deed action;CSM <br /> 3S4G 7-1K4F. /A-4't C 1iaSS hGN r w.3 w,r ance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 198 - 4/7S $Z4-/Grp 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ..5#1.MA.. hic.S 4.8 Q v4. /,.tkilee j ,r"' 017 mfr. LGC alSite Ian including location <br /> AGENT ADDRESS CONTRACTOR ADD SS of ell/septic <br /> 6.5.c G4Q.v.vd ri7oA) "L ogi <br /> (City,State,Zip) (City,State,Zip) a ackS <br /> `1tp€so�/, u�S S37 /9 <br /> PHONE PHONE Ite Flames afl7V r <br /> 60P- T26_ 1p45 a Icaia bletownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Fl r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ frc (tage drawn to scale. <br /> NUMBER �� �p67"���'�J~y/b �c -i as.3 /¢cis [�/ <br /> TOWNSHIP: SECTI . <br /> 50,Z l Nla/A L€ '/a: N %v.,: Y\-) Driv ermits <br /> ADDRESS: <br /> ate,county,town) <br /> 2 ,38 C f-y . NI w., P Air-. de,t.t. <br /> CSM: LO SUBDIVISION BLOCK/LOT ❑ Sanitary <br /> t 92.Y 3 (p • ,private) <br /> PROPOSED PROJECT INFORMATION ' <br /> PROJECT DESCRIPTION: ` -' t , \.-L!' �:v <br /> ,BYOB plrS r31 d9 (Q Y 0 . °� <br /> WThis project is a new building or structure. �Y s f - '„ , , , ; <br /> ❑This project is an addition/” eration to an existing building or structure. gy �� <br /> SANITARY SERVICE: ,.rE, s 4:: <br /> ❑SEWER SEPTIC �a ss� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - � 'sp " <br /> AREA TO NEAREST SQUARE FOOT: , ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ® a3 °sa ' � w <br /> a • (, ? o TOTAL SQUARE FOOTAGE: s z� - �� <br /> 4/i 4f. jr. i <br /> 2ND FLOOR: 3RD FLOOR: "� s ,, <br /> , <br /> —d � <br /> ESTIMATED CONSTRUCTION COST: �� :" <br /> (Please round to nearest dollar) "� ��� �� ., 5 ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes 'No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes INo 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? 131 Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 98 a ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) )4 Yes LI No ❑Don't know <br /> 7. Is this to correct a violation? El Yes ONo <br /> ., <br /> .// r-�� <br /> o► , c)1 d APPLICATION MUST BE SIGNED <br /> 545-112 la/oe> <br /> — (Continue on Back)43 G 5 . — <br />