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!4 -LuiptEMENT ti_Web App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> p ROPERTY CYVNER INFORMATION' x1: ry <br /> _._. _-, �..-:��� _�; ;;.��_ -,Y �� CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> - 1am' °11i154- Ing Status; CUP; <br /> WNER ADDRESS (Number,Street,City,State,Zip) � triction;CSM eed V7to31 {-k '1-1£1.. V-Kkerk,L. t_I-.1 u>OuN t 1�Z . 3�`f- Variance(# ) <br /> HOME PHONE CELL PHONE Et-MAIL ADDRESS • <br /> CdS3' gz7.oil+ �ik3 i34o c. r' 1"e M M e\ke-FMS (\e."\--- 11:1,Si•te-PI'an drawn to scale <br /> AGENT INFO!RMATION . - CONTRACTOR .-n° - r_� and includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME y <br /> /V—{ t1'i4 'C • e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ��` " of well/septic <br /> i(0�\ E Iv�w . <br /> (Ci e,Zip) (City,State,zip) S acks <br /> PHONEE�IPt ��7�`j3 ❑Site Plan royal from <br /> PHONE (c.CS ,ts27, 037 - appl' e t wnship. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> ,f-' -%- , -1-Q„ -k- F or plans to cale <br /> PROPERTY/L'OCATION INFORMATION (fittpalaccessdane co_dane w�us>MW V41 El ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE _ P P rty <br /> ❑PARCEL t I ontage drawn to scale. - <br /> NUMBER v7D82oZS�l� t <br /> TOWNSHIP: SEC ON: Z O,T'1 t, ' Yt 'Fs <br /> h117Pl-Gia 1 1/4: Kt %%4: ❑Drive - •-rmits <br /> ADDRESS: J (state, nty,town) <br /> ia I kkocTk- tz-(•lost-lA-D ❑Sanita •-rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ' kid- �...> . • (Puy pn ate) <br /> • <br /> .PROPOSED PROJECT INFORMATION `', L ',S F REVIEW <br /> PROJECT DESCRIPTION: it cdiR,rd5�b. ' k_{- 1�pD1-R°►A ( � x'" '� , °, . ,x� -• <br /> rV��� 12xl' I t_ oning Distract . ` ``4 <br /> This project is a new building or structure. 4 _ -� r>� <br /> Pet ed`lJ.se..,�t xh <br /> This project is an addition/alteration to an existing building or structure. _ �; 1 'M, <br /> SANITARY SERVICE PERMIT NUMBER Rru ralA•• A-!V4 T <br /> IEWER EPTIC AI Ct1eW7 ;,•7A _ <br /> HEIGHT IN FEET NUMBER•F ST.RIES: (Not including basement) Y -�`- i , ' <br /> ®xWe"t arn• Io(id•din/7. -r <br /> Sho1e ctlment): i <br /> AREA TO NEAREST SQUARE FOOT: t _•r .,: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ^- ?`* •Y; , ='irk= g <br /> BASEMENT 1ST FLOOR �� =� ErlO OrltrO pE�tml i . I TOTAL SQUARE FOOTAGE: ,, .slopes •t' •Tree t: • <br /> rf�luiglaccess' ` <br /> 2ND FLOOR. 3RD FLOOR J c`""""r' 3r� 7`' 3 F <br /> evie ,Loc <br /> ESTIMATED CONSTRUCTION COST Q� _ands.aiii3bie-o_'(5t n :.. <br /> (Please round to nearest dollar) ♦ '∎ '♦ '♦ ♦ ♦ "eAVIS:'t= 1:`. _:`r'- " 'f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? / es to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Yes Jlo <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 ! o ❑Don't know <br /> 7. Is this to correct a violation?- ['Yes r o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) --► -► -► <br /> 545-112(4)08) . <br />