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=4UPPI.I:MENt itioA eb Apps#:: <br /> ZONING PERMIT APPLICATION www.countyofdane:com <br /> III <br /> ;pROPERTYOWNER INFORMATION' r .-. - , ,-' .3 0,_ 54 Wr-i tom^ OMERTo PROVIDE <br /> OWN NAME <br /> l<us5 E gIi/-c ' • oningStatus; CUP; <br /> OWNERADDRESS (Number,Street,City,State, p) �� ( bee estriction;CSM <br /> b. ' al c -rN (J 'etvN YU_;= • <br /> a ante(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6O 9-fig/-3 yO(o ,0._,SlS;-S20o 5--e W aA/t_S C (;.0(wtcI # C (!'L • ite Plan drawn to scale <br /> _AGENT°INFORMATION, ,CONTRACTOR�INF.ORMATION'7. V5- ` <br /> � .�:-= -,.. _ _.�..�. � s�� ir n includes dimensions <br /> 'AGENT NAME , CONTRACTOR NAME <br /> . S e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑Site Plan rov om <br /> plica to ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> Floor ans to scale <br /> PROPERTY/LOCATION INFORMAT_ION ,(littp llaceessdarie eo.d_ane w use ' � <br /> PARENT PA EL NUMBER: RRENT ONING: ACREAGE❑ . Elevation Of prop <br /> PARCEL �L (� t \ /. frontage draw o scale. <br /> NUMBER a1© ?-__1)q_�Jo V • I �� <(Y ���-ts <br /> T SHIP; SE TI r �I <br /> .dK (( V OM '/4: i� /4/4: Yv ❑Drivew permits <br /> ADDRESS: ,,// J (Sts ,county,t0 ) <br /> '4 o , i<A 1e..e/11sb(Ae-c L MA z-0 ❑s.nitary its <br /> CS : LOT SUBDIVISION BLOCK/LOT ((ubli rivate) <br /> PROPOSED PROJECT INFORMATION - >;:STAFF REVIEW `{ <br /> PROJECT DESCRIPTION: 1 _ r`''^-; ;; r ' -� <br /> S e o. oning DISTnCt r '`, <br /> ❑This project is a new building or structure. DM Permlffe■ 4. n, ' <br /> ❑This project is an addition/ Iteration to an existing building or structure. - i*'"''f -'i <br /> SANITARY SERVICE PERMIT NUMBER Rural d.re sue. - <br /> rEWER PTIC - 4 (eW/ xlstlnir S'_ <br /> HEIGHT IN FEET f NUMBER OF STORIES: (Not including basement) �, <br /> 1) `/ `®.Wetland/Flo••p sin/ <br /> Shorelan o attach ) <br /> AREA TO NEAREST SQUARE FOOT: `" 1, -,fit <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ''"Ii- ` r w. �,,T r ,.. : <br /> BASEMENT 1ST FLOOR ��^)/\/\\�/\/1 °� EfOOnCOntr• pffllt' <br /> C '_rex �exn-.. r e5- <br /> 4.TOTAL SQUARE FOOTAGE: , SIOpeS dl got---.541,:x <br /> etii-Iirg aco-7_:,..S$ , <br /> 2ND FLOOR 3RD FLOOR r' r\ Y' "� .. <br /> 4 <br /> Revl`ew�Locati•0 SU y - <br /> ESTIMATED CONSTRUCTION COST: ¢ �� , ;-moo z� r` ptrarc ' <br /> ♦ ♦ -i --► -' ♦ W d a allabl3 o�5tlons :: <br /> (Please round to nearest dollar) ) -_ ;r,`: w - `" ';,3= <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - es ❑ , <br /> / <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• none) <br /> 6. Is a location survey required? (see reverse) [Yes r o ['Don't know <br /> 7. Is this to correct a violation?- ❑Yes -!4 o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />