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(uSUP,PGEIVIENTzio YYeti App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> _'ROPERTY OYYNEWINFORINATION' r _ .- ,.,:;�-7' -:::. _. '�_ w w x . CUSTOMER TO PROVIDE <br /> O ER NAME <br /> e .c15' ' Zoning Status; CUP; <br /> O ER ADDRESS (Number,StreetCity,State,Tip) <br /> G� G - Deed Restriction; CSM <br /> 3�3<� Q t. `3E 5 ,ob v\ 11.71 5 3 ( Variance(# ) <br /> HOME PHONE CE L PHQ E■AIL DRESS - • <br /> p3- • ^ d - vxvvvMrti.} 4 'U kev ,CO VV. . Site Plan drawn to scale <br /> ,sc�-:. - r .1Ts <br /> AGENt_7NF ORMATION _. CONTRACTOR.INFOW:4*iON-AgI_. + . and includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME <br /> Tv15 EISite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ["Setbacks • <br /> PHONE PHONE ❑Site Plan approval from <br /> - applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS ' <br /> 0 Floor plans to scale <br /> PJROPERTY/LOCATION INFORM ATION _`(http/laccessdane co_d_ane wi use _ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: . L <br /> RE Elevation of property <br /> ❑PARCEL /� �+ frontage drawn to scale. <br /> NUMBER D51 O .'OZ,��b421�d <br /> 12_14-/-2- �J ,`O g <br /> TOWNSHIP: SECTIO I� <br /> • VT.t_.pt-U _ I a y4. 'AY.: n Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION T g. pFF ZEPIEW ` <br /> PROJEC DESCRIPTION: >x z- , h -:, <br /> ` Wi t Zoning Dlstrlcttf <br /> his project is a new building or structure. Cr Perfhttfbd Use?rt r_ vi l <br /> ❑This project is an addition/alteration to an existing building or structure. � �-ti ^4 <br /> SANITARY SERVICE PERMIT NUMBER 't�J RUraIFAddreSS;,c 1, 4: f <br /> EWER ��EPTIC _t-. tri 7ewstingy `'- 1 <br /> h f e`Tip'-?. 'ii7 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) rµ , � ., ,.��Wit. ' <br /> I ii S and/Flootipial_n/ - <br /> Sho land(atta`chment), , <br /> AREA TO NEAREST SQUARE FOOT f-kf;3 , . ;,rs � µ . <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) '="I g=.6r r'r� <br /> BASEMENT 1ST FLOOR `® EfOSIOnCOntrA� k <br /> / TOTAL SQUARE FOOTAGE: .SIOpeS of rbance,:_,-4,-,,,A,,.k. <br /> lO 7,2 b 3 l -fitful a cess �, , <br /> 2ND FLOOR: 3RD FLOOR W tl"R t <br /> --- f -cns .4 "'- <br /> ly a Location St rvey- <br /> ESTIMATED CONSTRUCTION COST: z,., z `° '` `"`io `` <br /> QQ�� x� andavallbie�oit ons ,rf <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ 'P ='T°- :;` =y iS f g- `'=f* ° ,. <br /> ' 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes alo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ONo <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 alo ❑Don't know <br /> 7. Is this to correct a violation?- [Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) . <br />