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4SUPPLEMEN7#o YYeb Ap## <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> ;PROPERTY OINNE it INFORMATIONyr _ vaZI '„3 T-`1 F X ; = C TOMER TO PROVIDE <br /> OWNER NAM <br /> • ' A P 0"14(--t VI Z. ing Status; CUP; <br /> OWNERADDR- S (Number,Street,City,State,Zp) D-ed Restriction;CSM <br /> • cb 1�C�L�(i/J a /�� ariance(# ) <br /> HO Er P,HO �` CELL PHONE E-M• LADDRESS • <br /> (0°F.-616 - 'Alt,Y1 I 4/11 /L' A4 3 Ite Plan drawn to scale <br /> _AGENTiNFORMATION CONTRACTGIONFORMATIOWti` nd i cludes dimensions <br /> 'AGENT NAME CO CTOR NAME /�kP`ri <br /> fL,4© 6�e4[ C(�C(2/4i#4/ Sit Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 0 ell/septic <br /> (City,State,ZZp) (City,State,Zp) Setbacks <br /> PHONE PHONE ❑S. Ian a oval from <br /> p lira township. <br /> E-MAILADDRESS E-MAIL ADDRESS • <br /> F oor plans to scale <br /> PROPERTY/LOC ATION INFORMATION (http l/a ccessdane eo dane wt use <br /> PARENT PARCEL NUMBER: U TZO G: ACREAGE Ievation of property <br /> El NUMBER C610 _ /014 - )/ S` I( �.^ e r. <br /> frontage drawn to e. <br /> TOWNSHIP: SEC <br /> �j✓I,�C C %4: SE. %1/4: col,,) ❑Drivew ermits <br /> ADDRESS: J (St county,to <br /> '-'U°, :L VA-yc-t-'11(ie 17 12,.i/ . El .anita. permits <br /> LOT 1 ...,....,,./SUBDIVISION BLOCK/LOT <br /> (pr. lc,private) <br /> illMIi LLi" • <br /> PROPOSED_PROJECT INFORMATION =` , -, STAFF REVIEW �, <br /> PROJECT DESCRIPTION: , x 4 e <br /> )4. 10 k•I rLli- , ,(4-/ r ,A) Zon ng i Dlstnct rl <br /> ❑This project is a new building or structure. =� Petmltted ? ;n f'; h <br /> This project is an addition/ teration to an existing building or structure. L �` <br /> SANITARY SERVICE PERMIT NUMBER: y� 1®-Ru I`.ddress 4 °ice <br /> FTEWER [ EPTIC / N. _`y (new/•xistm ` 3 <br /> HEIGHT IN FEET R NUMBER OF STORIES: (Not includin basement) <br /> K <br /> i ® Wetland/FI• dpii.. <br /> AREA TO NEAREST SQUARE FOOT <br /> 4:,,,..v,SholeIa o"(a tachm <br /> -. 4 4� •-F :47,, i <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) s r �'f�., <br /> Ero onContr� pEtmlt' ' <br /> BASEMENT 1ST FLOOR: `-®" _ - �n g. <br /> -a 0 l TOTAL SQUARE FOOTAGE: 4, slopes ai urbance_ , <br /> 2ND FLOOR 3RD FLOOR t f lIi g�7a ess0 <br /> fl Re -wiLlbeati it Survey <br /> ? z � ,(STIMATED CONSTRUCTION �z.-and avallabe optionp <br /> r; <br /> Please round to nearest dollar -I- -0- -0. ♦ -10- -0. a� i _ ,u _ ,t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? VAI es ['No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 111 es 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? - Wes RN <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none) . <br /> 6. Is a location survey required? (see reverse) 01'es No ['Don't know <br /> 7. Is this to correct a violation?- Efres ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -9 -► -► <br /> 545-112(4/08) , <br />