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4 up LMENr#owwb Ap ZONING PERMIT APPLICATION www.countyofdane.com <br /> pRDPERTY C NNER INFORMATION? e' r -" 'u=,�- <br /> __ -L Y:4; ,":44:_ .-:.,r��_ ,Y_r-r, i Cu TOMER TO PROVIDE <br /> OWNER NAME <br /> Orr 5t-( b ._ Zo - g Status; CUP; . <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> �t( WOr 5< R D V is Restriction; CSM <br /> 13 -( 3 (}O SQ <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6'. —?'I I -0)333 Mss ; be 11 3q3 ea-Alit.C.cJM ite Plan drawn_to scale <br /> AGENT INFORMATION : CONTRAC JORt INFORMATION 4 <br /> _..- --- .�� _... .�_. n. .�... .-...�..�, M and includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME Q <br /> <4-(Z. 122vyl.oc:t e_L'vt5 SCO Tr l�yL4evA/e " ❑Site Plan including location <br /> AGENT D��S � ��^ �� CONTRACTOR ADDRE S {well/septic • <br /> (City,State,Zip 2 (City,State,Zip) E 1 Setbacks <br /> AAact'So'A IA) ( <br /> PHONE PHONE [S' e Plan proval from <br /> G <br /> 60 (*" 222- p0L( 4 - plic e township. <br /> E-MAILADDRES E-MAIL ADDRESS • <br /> SC_o it srrtinoc e.tr ,Co/ loor plans to scale <br /> PROPERTY/LOCATION INFORMATION pis 3 <br /> (http//accessdane eo dane w�,usr _t <br /> PARENT P U ER: �p� RR ZONIN ACREAGE ❑Elevation roperty <br /> PARCEL � � `"d�(,p� �� �. fronta drawn to scale. <br /> NUMBER . <br /> TOWNSHIP: SECTI � I`^ � <br /> N KJ , , 1v Y V 0 Drivewa ermits <br /> 7�r�5 °i� 1% r v �` 4: (stet county,town) <br /> ADD1 E 3. ct 3 i4 b l 11 &'Se_ R b . []Sanitary its <br /> CSM: LOT S BDI$ION B 0 K/LOT <br /> 6 S (/ .ubli rivate) <br /> is'r•S- <br /> PROPOSED:PROJECT INFORMATION -: =- r'- x y STAFF REVIEW <br /> PROJECT DESCRIPTION: l4t <br /> -6 V,� €C-i.< l X / ,oning District r <br /> El This project is a new building or structure. kii. <br /> ❑This project is an addition/alteration to an existing building or structure. "P ' ,�_-'.; X <br /> y <br /> Rur IAddres 9 <br /> SANITARY SERVICE PERMIT NUMBER I V ( #® ,w - ,,,v -- r3 <br /> [EWER EPTIC 5 jne /existing <br /> HEIGHT IN FEET ( NUMBER OF STORIES: (Not including basement) ® , <br /> Wetland/.F dplain/ <br /> AREA TO NEAREST SQUARE FOOT 4Shoel d (attachment) <br /> r a <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ® j t r} <br /> BASEMENT 1ST FLOOR <br /> _EroslonControf mlt' ' <br /> 4,TOTAL SQUARE FOOTAGE: ♦ »(SIOpe dls � ._ <br /> 2ND FLOOR 3RD FLOOR 13 S fIIIIr glac• ss� J�}, : r1 <br /> ESTIMATED CONSTRUCTION COST: =-7°:R,e- ew-Loea on SU ey_- <br /> ,♦ --I- ,♦ ,♦ ♦ --0 41 7 Z/ �� it and avallabie options <br /> (Please round to nearest dollar) G „� l'gF u,., ,r, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes o 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? - [Yes [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 /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) –► ■ —O.545-112(4/08) <br /> • <br />