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• <br /> s. <br /> SUPIPLEMENT;#o 1N_e6 App#3 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> . t <br /> pROPERTy4wNER-INFORINATION :- _:F .,ig r -i iIit f. ,* ,,A:: CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> l <br /> f".1 -el-C. Y v's 4_k Te) j► l rl •C' 6 K�, NZ5ning Status; CUP; <br /> OWNER ADDRESS�(Number,Street,City,State,Zip) - peed Restriction;CSM <br /> I.7 2a Rash ©11,0 1 I� aA.,d Variance(# ) <br /> HOME PHONE ELL PHONE E-MAIL ADDRESS i <br /> a <br /> ' S.' ®Site Plan drawn to scale <br /> . AOONT`INFORMATION, ._ _CONTRAC[OR'INFORMATION t-7-- ,` a I includes dimensions <br /> 'AGENT NAME CONTRACTOR NAM / <br /> . rrk-g, CO f7i!,t e- .v bV iCS' ❑Site Plan pct(ding location <br /> AGENT ADDRESS CONTRACTOR ADDRES rof wellleptiC <br /> /l/?? .7 ,lltA,T <br /> (City,State,Zip) ((City,State,Zip) 7 O Setbacks <br /> PHONE PHONE YD e� 1‘ � " ❑Site Plan proval from <br /> T 4-”,: !ol 9'•••••...,....•.. ,••...... Oatf e �o� 5 � �l 7 a pp ica yt a shi . <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ❑ , oov1'ans to scale <br /> P.RO PERTY/LOCATION INFORMATION (http llaccessdane codane vvii usl-V ?. 4Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE <br /> • ❑NUMBER O A—/(�X) $ frontage drawn to scale. <br /> TOWNSHIP: . SECTION: 1 0 N P. i i L S o c it6 <br /> p).e0,5Q,n— Sprirg s 13 /. WA: ;.j <br /> ❑Drivewa ermits <br /> (state ounty,town) <br /> ADDRESS: . <br /> !65/0 Ko5i KO0ony Rat• ) 5 °4'` 1m r), t,�)-L ' <br /> ❑Sanitary p: its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, ivate) <br /> PROPOSED.PROJECT INFORMATION -'. STiAFF REVIEW r <br /> PROJECT DESCRIPTION: <br /> ~tel''' -'' <br /> L, ve,5-fock She -e.i- ' L/ ( + <br /> :Y ornng District r# <br /> This project is a new building/Sr/br structure. f r 'aii `" t <br /> P i g g Permltfed Use? , <br /> This project is an addition/alteration to an existing building or struc u s `_ r; , gr <br /> SANITARY SERVICE PERMIT NUMBER I(EPTIC �j HEIGHT IN FEET: NUMBER OF STORIES: (Not in i'i <br /> ding basement) v F � L <br /> =� Wetlandf lo�tiplam/, <br /> - Shotela (a'ltachfie)- <br /> AREA TO NEAREST SQUARE FOOT -� k.ri--`5 .—� • "�""a -. '� . <br /> r x ey <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) s j- s * s�� , <br /> BASEMENT 1ST FL R >0 EiosionControFpmit <br /> —)�Lit j,TOTAL SQUARE FOOTAGE: j, ;v' slopes C�1,5�lrbanc� �_ • <br /> • <br /> C?t tr <br /> 1 1 thknglacc ess) <br /> 2ND FLOOR: 3RD FLOOR: , ! -ita f v z _ R <br /> ��Revlew�Locafio SU ey. <br /> ESTIMATED CONSTRUCTION COST: t5 U ' 4•Q �t uric available options} r <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ •� ...x SP47-: �U,, ,; <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? •Dies la No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? :Yes c o <br /> 4: Has there been a zoning permit issued for this property in the past 5 years? - ❑Yes VINo <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 gplo ['Don't know <br /> 7. Is this to correct a violation?- Eyes MNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -► -► <br /> 545-112(4/08) . <br />