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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# - <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME <br /> iii F1 C, � kb L I-�vi sc4 1 6 <br /> Zoning Status; UP <br /> OWNE ADDRESS (Number,Street,City,scare,Zip) Deed Re(trict' ; WJ,/) t/� <br /> 2.14--/ C h-e r o/<ee Rd #7 /8.2a v-e+^ Da i i GiII 539/6 Variance # (l- <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS t <br /> 603_ s7 if 0013 p Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME t A 114£S Ti ER iv 6 y CONTRACTOR NAME A <br /> l a N L y /3u I CJ S' LL SQYkv "4 S' - - ya.•: ..'-. location <br /> AGENT ADDRESS CONTRACTOR ADDRESS . f <br /> /v i'- /(fk; 2d AOIL(City,State,Zip) (City,State,Zip) kSetbac �/, <br /> /i,i_„v c fe nl ) W,f S39(( i <br /> r PHONE PHONE P Site Plan approval fro r <br /> 6.03-635-tf5-3.-y4 ,1 6q5-82-83 pplicabletownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> OA Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.daneACREAGE:.wi.us4 '►' Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: <br /> ❑ PARCEL I g h— 2 .1 V 7 7 frontage drawn to scale. <br /> NUMBER / <br /> TOWNSHIP: SECTION: (o,-r 9 A/ u to _./� <br /> W I n d so R S L 1/4: S'14.1 %IA: (Driveway permit �//.f{/ <br /> ADDRESS: (state,county,via <br /> G I, n ferkl /l a(, 0e Are41 WI 53.532 <br /> Sanitary pe .•its <br /> CSM: 1 2-'f 'LOT SUBDIVISION BLOCK/LOT (public, vaip <br /> PROPOSED PROJECT INFORMATION r n ; <br /> PROJECT DESCRIPTION: r,,-L, 7 <br /> 1) El.() Si N G L t I ,�-}o + . � � . <br /> . This project is a new building or structure. <br /> e ;k N /4.: <br /> ❑This project is an addition/alteration to an existing building or structure. i. <br /> ,:.-1 ,I-. .t <br /> SANITARY SERVICE: r <br /> PERMIT NUMBER: ,� � a ,, f <br /> ❑SEWER s-SEPTIC S/3 0 6 S �� . <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) -i. } � ir <br /> l u'w <br /> AREA TO NEAREST SQUARE FOOT: � �� � ` >i <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � � ,; <br /> BASEMENT: 1ST FLOOR: . <br /> ( 5� 3/24 TOTAL SQUARE FOOTAGE: ` l e =I �t ,iV - , - <br /> 2ND FLOOR: 3RD FLOOR: / <� 3 r . ,- -' <br /> MA N A4 <br /> ESTIMATED CONSTRUCTION COST: " � s <br /> (Please round to nearest dollar) "p -"* ♦ "♦ ♦ -•► OD -F • '. $ <br /> yS��0 tl-o. �> ; am <br /> 1. The prop:;-- wi i ': ee stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is the V a wetla►. �oodplai in or near the property? XYes ❑No ❑Don't know <br /> 3. Have y•. • •ed wi • •- ownship about your project and are they in agreement? ig-Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes s-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 ®No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®.No <br /> 1 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> 545-112(4108) <br />