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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web4pp# <br /> PROPERTY OWNER INFORMATION OFFICE!USE ONLY :,- !' <br /> OWNER NAME r <br /> - —DaIvF)L>7 L . <br /> S - e-/YI.ER_ .0 In ast t <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 5352 -S_£ Q rjc _�- <br /> Li3 % VIL.AS- HOPE kb, CQTTAGE GPol�� t-' v tte�- <br /> PHONE E-MAILADDRESS f,�efl�la'�I$e <br /> GoS D, --1-10c11 <br /> Zbatr&$fUS d . 1; <br /> AGENT INFORMATION CONTRACTOR INFORMATION <br /> AGENT NAME tti eec. R t[on CSIVI <br /> CONTRACTOR NAME 6 , r - i z, <br /> _ C L€A R " 60 ,.ce. #4 ..4 �- ..�i.,,_ . <br /> AGENT ADDRESS . .. <br /> CONTRACTOR ADDRESS <br /> O pA0 I T. �Hcvy coq S tail drawn to scale <br /> l lrtcIu - imensions� <br /> (City,State,Zip) (City,State,Zip) * ¢ <br /> C" 4 4, ems; <br /> \/'�20 NA) w�C• 5'3"4 3 270,14i7flialitinfaKON <br /> PHONE PHONE t. ,-v reggitatalgi <br /> 11, s( ,o$) .56- 13 55 : -0 <br /> j `E-MAILADDRESS E-MAIL ADDRESS k 3 7. <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) S_te pia 46e)•a3� .frun7 <br /> PARENT PARCEL NUMBER: ZONING. <br /> ACREAGE: � <br /> PARCEL - Q A •, 'j x p et nship _ <br /> NUMBER ©III OBI lL� I �� • � '1 I. �� '�-���, '��` � �. �€` '�.,� <br /> TOWNSHIP: SEC ION: ti i ' <br /> C0T746� (�vv� I : NE 1/41"—i .� _" ® z Riticav raw <br /> ADDRESS: • �� e?41In® t <br /> if39r , Vis is—Novi rz.A. _ ;� _ y. <br /> �* i � <br /> 4.'g' ie ayi�-3'xx xr ;; yam- l <br /> CSM: LOT SUBDIVISION BLOCK/LOTE � 9taCalk <br /> PROPOSED PROJECT INFORMATION Ar O '® � '�� �: <br /> PROJECT DESCRIPTION: ni : �i � C81B <br /> 2'7 X I-10 AbD,1T(olJ `b nu ..KIsrw6- OC T-BUILD /N G. Di— <br /> i <br /> ❑This project is a new building or structure. g Y _° �un�own): <br /> This project is an additio alteration to an existing building or structure. :- 40 NIM V <br /> SANITARY SERVICE: PERMIT NUMBER: ' p, n.A If. ' <br /> CI SEWER SEPTIC ., - �° W� ; <br /> >a � K � �_ � ��i- Vii: <br /> HEIGHT IN FEET ' r/ NUMBER OF/STORIES: (Not including basement) Li ®od ai / <br /> Lit /` �f�etiatcti R " ; <br /> P Ind (a c meth) , <br /> AREA TO NEAREST SQUARE FOOT: "�� <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) `' pr tg" o�' �Y i g <br /> BASEMENT: 1ST FLOOR: rosrlo � .' <br /> 'V 8C I j TOTAL SQUARE FOOTAGE: j 4Or' 0 ��� <br /> ��=�4illi ss) <br /> 2ND FLOOR: 3RD FLOOR: ,a <br /> r o 80 . <br /> Rev t418.6ation ey <br /> ESTIMATED CONSTRUCTION COST: '' -i , <br /> -► -► -0 -► -0 - . ( andf at`a r(e o tto s <br /> (Please round to nearest dollar) t QI�O _ -w n 4. .; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 71 Yes ❑/Nit ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes allo ❑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? ❑Yes '.No <br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# ) (le ve blank if none) <br /> 6. Is a location survey required? Yes <br /> ID Don't know <br /> 7. Is this correcting a violation? • ❑Yes Io <br /> 4 11 . —' <br /> APPLICATION MUST BE SIGNED <br /> 545-112(1/08) (Continue on Back) . -0. �-0 <br /> - <br />