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tlitiAEMENT;ti iii eO App'#:
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> :'ROPERTY OWNER'INFORMATION__'
<br /> - „- - Otft��� CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> 1 0 _54 8e �' i-S C n Zoning Stat ; C ;
<br /> OWNER ADDRESS (Number,Street,City,State,Z15}- Deed Restri • n; CSM
<br /> /�j ! / 7 Ah 0 54 4 ii ie r— _`c vi 'A ;t--■ Z W S35( b Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> • e gi y ' .) ❑Site Plan d aw to scale
<br /> AGENT:INFORMATION CONTRACTORyINFORM,AT_,ION£' ',ty and include Imensions
<br /> AGFNT NAME C NTRA TO NAME
<br /> I p t V. e-CU C D -7�, - ❑Site Pla i uding location
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<br /> AGENT ADDRESS CONTRACTOR ADDRESS `/ of well/s tic
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<br /> (City,State,t> WI .j / / v (City,14 LeF°! /4 d 14.l. _ • 355 �' ❑Setbacks
<br /> PHONE ' PHONE H ❑Site Pla• :..r v m
<br /> 'l/ - 8/ 9- -07 ' L L/ c d 7 --B` ,j $ - a -?63 aPPlic.,,'
<br /> - • ns .
<br /> E-MAILADDRESS E-MAILADDRESS •
<br /> •YTM 7 ''10 9 - t"►a' ( , 6c""" j n F i› @ ,4 , /t, tw Cdr ❑Floor pl o scale
<br /> :PROPERTY/L'OCATION INFORM ATION htt //accessdane co dane wwii
<br /> ( P � "` � "`` n Eleva n o roperty
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE
<br /> ❑PARCEL frontag yawn to scale.
<br /> NUMBER
<br /> TOWN : SECTION:
<br /> SH 6,n ij1o ' .
<br /> %4: 11/4%4: ❑Drive i
<br /> (state o
<br /> wn)
<br /> ADDRESS: J
<br /> l C R i �a 0 S /t4.1�-e
<br /> v- ❑Sani i
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (publi ,
<br /> PROPOSED PROJECT INFORMATION - ' T 'SYA F IZE-�/IEIN > `�.
<br /> PRO/JEC/T DESCRIPTION �Q � := �jjjjj,,,,,�,,,, / r , � �i' s.
<br /> 48 a �K✓L e00LY1 D "t �I e-CY, 7"- "i1 eit y. 14 -Ph e ate✓- `"/ �-C]'Zoning nct }r/
<br /> _ �941�*�k.� �`S' K-�,'' .t�.
<br /> . ❑This project is a new building or structure. Perms se?ter ,;^V
<br /> This project is an addition/alteration to an existing building or structure. - g �'' ^"4
<br /> R`ural`Add=ss= :4,„ c
<br /> SANITARY SERVICE PERMIT NUMBER -(new7e r f J'-
<br /> r)EWER �EPTIC .,-ti y�r
<br /> HEIGHT IN ET. j / NUMBER OF STORIES: (Not including basement) ' $ y, ,.„,'�, k 3
<br /> A-vO� 12'f = Wetland/F o p
<br /> J klShorela , c-h ent)
<br /> AREA TO NEAREST SQUARE FOOT 4f ` : Y",' " s
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ., ^ r^ "" 'r- =,.
<br /> ® E=rosion o •
<br /> BASEMENT 1ST FLOOR: :}„ . It
<br /> 4,TOTAL SQUARE FOOTAGE: 4, � Sl pe pis 4 , -
<br /> tiiiiin a cess :. . :,S------:;
<br /> 2ND FLOOR 3RD FLOOR ] 6 G �'4:�. _t:_--: J-„,ai,': `?=�`': 7,,4
<br /> I c t�4-�i-- r- a%.a.2-,f
<br /> "•its. n.. `,Z- ,
<br /> 1,Review4Lo• ti.a e
<br /> ESTIMATED CONSTRUCTION COST: �-�` F Jam'-�3nd II ∎I +Tt-• - r
<br /> Please round to nearest dollar) V I 7 r�
<br /> ♦ ♦ ♦ ♦ ♦ ♦ V :.ems t. r' v;„
<br /> \ ) 'ice . r esw.7 r�� _-cam?t r.+.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes go ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeslo ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes r'i.
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - aes o
<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 ZVo ❑Don't know
<br /> 7. Is this to correct a violation?- ❑Yes M, o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Sack) ■ -► -9
<br /> 545-112(4108) .
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