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• <br /> IsittoLEMEN7 to vito Apple <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> • <br /> `p RDPERTY OWNERINFORMATION <br /> e.:::;. ;J r ���;a ; Cu•TOMER TO PROVIDE <br /> OWNER NAME r <br /> �UR ETAGO��I�YI Zo ing Status; CUP; <br /> O ER�S umber,StreeLCity,State,Zip) <br /> 45013 \�a -c;\v: Ml' G`C"v Wt"' D ed Restriction;CSM ) <br /> r• nce # <br /> HOME PHONE CELL PHONE/ >/ E-MAIL ADDRESS • - • <br /> o�, -556- /q Ow e. GmeA„ 'C " ' to Plan drawn to scale <br /> '�'t f, , f_, - <br /> AGE NT1N'FORMATLON_, , CONTRACTOR�INFORMATION_-�_•��,�_ t ,� nd includes dimensions <br /> AG ME CONTRACTOR NAME <br /> J` l'`�oLkjtP l 1 . M 1 �71r'I`ew► ' \kkr-S Si Plan including location <br /> AGENT ADDRE�S CAI NTRACTORAgDRRESS of ell/septic <br /> (city,Stale,Zip) (City,State,Zip) etbacks <br /> _ (l. vvlA k-e-e w?5351 <br /> PHONE/,, PHONE// 8,11_6916 ❑ ite Plan proval from <br /> ( o r &i -5 1 C�0g— applic e township. <br /> E-MAILADDRESS E- IL•DDRESS FIOOr plans t0 ale <br /> `PROPERTY/LOCATION INFORMATION (http//accessdane eo dane w.us) W � ❑Elevati of property <br /> PARENT PARCEL N BER: CURRENT ZONIN • ACREAGE . ". _. <br /> ❑PARCEL © 0 9c) '1( 4 Q„0 „ 1 front e drawn to scale. - <br /> NUMBER V GY'n( • <br /> TOWNSHIP: SEC <br /> • tik- ,/4: ,j //4. N to ❑Driveway rmits <br /> I (state, unty wn) <br /> ADDRESS: , <br /> � e c � Q \l <br /> • ❑Santa ermits <br /> CSM: LOT SUB'!AVON ",S BC <br /> 1 � (publi ,private) <br /> GS <br /> `t`ti ' .. 011 . <br /> PROPOSED PROJECT INFORMATION ''"''.TAFF REVIEW <br /> PROJECT DESCR PT10N: <br /> i p Ar-7 4 z<4 T <br /> 0// l `►& /n' / � r niNg District t3 y,' , , <br /> . ❑This project is a new building r structure. % Y r <br /> erm Oils project is an addition/ eration to an existing building or structur ,. .� x ,y} <br /> r. <br /> SANITARY SERVICE PERMIT NUMBER: t\ '� Rural` ddresss °�- - <br /> EWER EPT1C _ <br /> HEIGHT IN FEET q r NUMBER OF STORIES: (Not includin asement) =" �` V 11 ' ` ' <br /> ® Wetland/F .•dp1al /_ <br /> • Shovel d"(att c►•"ent) <br /> AREA TO NEAREST SQUARE FOOT: Fir- _;; ?-s, : <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) EoM oCon • reTrsmrx <br /> BASEMENT 1ST FLOOR: <� 1 g p2q, . U a e •z �: <br /> 4,TOTAL SQUARE FOOTAGE: <br /> Wife_ :g a - 6,6s -} 1 _• _ 1 <br /> 2ND FLOOR 3RD FLOOR tea- "r-'j a,- 'sa- _cu <br /> f U. <br /> 1- e iie -`Locati.d $ `y' <br /> iii. S(TrVe �- <br /> ESTIMATED CONSTRUCTION COST: Q• J�''�} ' °M -.4*Ir i <br /> (Please round to nearest dollar) '♦ ♦ ♦ -► --∎ ♦ ( l O© x"'`"" r4'. ''=;if f,',.- <br /> ' 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes -larfo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Peso ['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? - 121.is ❑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 • aro ❑Don't know <br /> 7. Is this to correct a violation?- [Yes EiVU <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► -► <br /> 545112(4/08) <br /> '41 � 1.(:.:(1) . <br />