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',...50.00:100417,341*ObAiiiiik <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> :RO ERTY-OWN •IN ORMATION' ' CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Pere/ 'ci— re a4" �i'l c � n Zoning Status; CUP; <br /> OWNERADDRESS (Number,Street, ity,State, P) Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E MAILADDRESS - <br /> 225 -aef3 PeJ4er -ile,e170 -• co ❑Site Plan drawn to scale <br /> _AGENT1NFORMATION ,:. _= ;CONTRACTOR INEORMAT,ION_ �.� `' <br /> _ .. � ..�. . _�__._.,.- .�,.>. _�.,r�� and includes dimensions <br /> AGENT NAME , q CONTRACTOR NAME !! <br /> rf U)a,17z Le i/ CUSS go n, ,t ❑Site Plan including location <br /> AGENT ADDRESS CO CT ADDRESS of well/septic <br /> 7602 R:ve cfacr ,P. . <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Ve't9,10t- Gar53593 <br /> PHONE PHONE El Site Plan approval from <br /> " <br /> CC 27%- V-7 9 - applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> Tek.5h .J ' •;, 44 aCpl n Floor plans to scale <br /> `PROPERTY/LOCATICN INFORMATION ,`(http//accessdane eo lone wi us/)_ <br /> PARENT PARCEL NUMBER: CURRENTZON ZONING: CREAGE . ❑Elevation of property <br /> ill PARCEL J� /�y / Li frontage drawn to scale. <br /> NUMBER U F/v`252-6 ?.1 `3 - • <br /> TOWNSHIP: SE <br /> 5 too" <br /> oo"N'►+ {0 U %4: %%4. ❑Driveway permits <br /> ADDRESS: J (state,county,town) <br /> CSM: g��l / LOT K fk-✓`� ❑Sanitary permits <br /> SUBDIVISION BLOCK/LOT <br /> S , ^ <br /> i l I i i (public,private)• <br /> :o' . <br /> PROPOSED PROJECT INFORMATION "STAFF REVIEW `{ <br /> PROJECT DESCRIPTION: x= >t J+' <br /> c4�h re 7 �/ �,�s-Zoning Distract . ` <br /> [/]This project is a new building or structure.' M' >,��k <br /> �+Petmltfec)Use?�7�.x r , <br /> ❑This project is an addition/alteration to an existing building or structure. ta' _ F 4y. <br /> SANITARY SERVICE PERMIT NUMBER d '`❑ RurarAddr SSy.L 'ter <br /> �EwER EPTIC �3 .-.�7-0605 / *4-4'Cne 7e sting�� . ';_ <br /> r , F <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) , i '`r• '4 `'_>�.""-' <br /> / S ® V�1e` arDd/Floodt a /�.1� <br /> ( / ^ Shoreland(attachrDent) <br /> AREA TO NEAREST SQUARE FOOT: s:.s` ,,W�` �••=�_: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) 3' -., 1 -,:e4.; 'r <br /> BASEMENT 1ST FLOOR ®E SgL1COntrAl- t <br /> �^ �CV35� j TOTAL SQUARE FOOTAGE: f Iperbanc ` <br /> •2ND FLOOR (� 3RD FLOOR I g access :$ <br /> eC77746 571 1 l�lRe3' <br /> lewLocati. TSrvey <br /> ESTIMATED CONSTRUCTION COST: °'a -� raailab onV <br /> " <br /> (Please round to nearest dollar) —0- —0- -0. "♦ —0- � 3 J � M '' z :- 4V./ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes `.. ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Oires 1111 o <br /> 4: Has there been a zoning permit issued for this property in the past 5 years? - ❑Yes re o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# /1 k ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) []Yes ❑No /0Don't know <br /> 7. Is this to correct a violation?- ❑Yes pl o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 54.5-112(4A8) . <br />