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, (itc(u.�e 11M-16e . ' t <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ke(Pi�,,//�_ ...� e <br /> !D/''1 .4' irUit1, moo. �E� E� ❑ Zoning Status;CUP; <br /> OVNJERADDRESS (Number,Street,cry,Sate,zip) Deed Restriction; CSM Z r'0 r2G►r� <br /> 7yy8 FsH • ,co��� �'gr�,r L✓/ S3j�3 Variance(# ) Ma,,.�-j„ <br /> ��H+OMEPHONE CELL PHONE E-MAIL ADDRESS V (�� <br /> (t o, ZS6•,'Z.i ((o, - ;z40 f' c�S•s✓ S�'.E�u Site Pfan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> f.g61E i¢?p6S,IT,er /,,ie Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> S'�l sYe9o,PE STiEc�T <br /> (�Y Slate,ZIP) (c' State,zip) Setbacks <br /> 49vx e.>y w� S3s�3 <br /> PHONE 7‘08)NEsrte Plan approval from <br /> G 51„3-51d 7 p 1 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS , lour plans to scale <br /> 01LAvrr✓. '�° 4)t. Qe) ors p <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wLus/) �-,� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Jr. tfevation of property <br /> .L' PARCEL frontage drawn to scale. <br /> •NUMBER <br /> _ ES�vE7.1T/�[, <br /> TOVYNSI/�j�J��y p'// SECTION: <br /> /`✓/� 'L14 1/4: WA: riveway permits .I. <br /> ADDRESS: p (state,county,town) .. <br /> 7W O 45 �9x'ce Z.4 i.) anitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION AFfE ' '`_?:_ " <br /> PR ECT DESCRIPTION: �� OLI S {� 0(41,-1°1 <br /> g pis <br /> C-,�L/k'E• 4:��vST/•✓6 ,�ESis✓�c< <✓i rs� .r�c�✓ �o�� 610 � <br /> ®This project is a new building or structure. �, � . <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ��+>»> s<5 »>` �� <br /> ❑SEWER W PTICI# :. Y � <br /> HEIGHT FEET: NUMBER OF STORIES: (Not including basement) I �� <br /> C (-2A/ y <br /> 2 r o t �,, <br /> AREA TO NEAREST SQUARE FOOT: �� <br /> (Outside dimensions including unfinished area,attached garag d e grade decks or porches) <br /> BASEMENT' i 1ST FLOOR: .2.-'. l ionC[ntrof p trait <br /> TAL SQUARE FOOTAGE: j .dI � <br /> 3RDFL��R: <br /> live F .2NDFLOO 7O ��Lk 1 ) P141 y <br /> ESTIMATED CO TRU •N COST ♦ ♦ ♦ ♦ ♦ ♦ 1f) 1 <br /> (Please round to neare dollar) <br /> 30 , oozes , .... . .. .... . .. ........... <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 NI No ❑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 aa No ❑Don, <br /> t know <br /> 7. Is this to correct a violation? ❑Yes �No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -P -P <br /> 545-112(4108) <br />