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atuCLEMENT 'f1AI.b A,pplit <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> `p7-ROPERTY MOR INFORMATIONIM-_ O M-- ="-Ari.:45* *°*- ,�,_' j:;: Gus MR TO PROVIDE <br /> OWNER NAME- I c ` l <br /> ((NC) OA C), L . J L'kckl `€r Zoning Status; CUP; <br /> OWNERADDRESS (Num er,Street,City,State,Zp) Deed Restriction; CSM <br /> 2 7 k( /V t�Oc` , ` <br /> ` P� ,ei ,� -�5"3l Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ^ <br /> d 3/69 tkl(e • il: c'71/1Cd1sdir,C`Crr Sit Ian drawn to scale <br /> lAGENT'1NFORNIATION*; - a- 3 CONTRAC OR INFORMATIONS r nd includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME <br /> - e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se is <br /> ( it Stale State,Zp) (City,State,zip) tbacks • <br /> PHONE PHONE Site a <br /> n proval from <br /> - applic le wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> LOPERTYILOC#TION INFORMATION A° tt i_accessdane coda ii i i �=- <br /> m`P.. 1-'� vation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: P P r <br /> PARCEL / ,, rontage drawn to scale. <br /> NUMBER DSO (�t/r` Ys�� _ �TOWNSHIP: nA S^e_ ,ON: O 11 V t ��F�v`t lk�i('()Se ' /4. 6'E //4_ n DriVe a rmits <br /> ADDRESSS:- (sta , c unty,town) <br /> 71O / 6, Sc 1 ' teV' (k.)-tt.t( WI S�.SQ f Sanit permits �� <br /> CSM: LOT SUBDIVISION BLOCK/LOT f v n <br /> 'V� a IC, ivate) J! <br /> :PROPOSED PROJECT`INFORMATION `fir:: -. 5.:y" _r �. r� l` pF REVIEW'' ;r <br /> PROJECT D CRIPTION: r . ` �1 `-- >s S .. z , d•/ Pi` P(1� o 1,��'Ul a u.�^ U■eu) �iY\� _� onfng ct 9 : a 'a�, <br /> F This project is a new building or structure. .. 'r '� r' x,- <br /> P mltfed Uses rc, �ri <br /> This project is an addition/alteration to an existing building or structure. "y � y g-3`-�s1`'; <br /> SANITARY SERVICE :®�-r• _`..-��+y �- `yr� 4 �'r' <br /> PERMITN BER: ► ral`Add ` Y <br /> EWER �h 14/A t1/�, (ne i XIS g a f�� <br /> EIGHT IN FEET i / NUMBER OF STORIES: (Not including basement) Y t'x �Lc <br /> SO'->f-_� 1 et- lo. . aEV <br /> AREA TO NEAREST SQUARE FOOT rk '�, , n oar�tachmru m * D <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ; __'., -�,,,._k�r.,Y; `:.D <br /> BASEMENT 1S FLOOR r0 lOnCme- pUfil �.4.TOTAL SQUARE FOOTAGE: 610 es,�dlsturbanc Yom,. <br /> $ f fifil acs essk t <br /> .2ND FLOOR; 3RD OOR -' ` <br /> 0 7 Revwocatlon Su ey ' <br /> .ESTIMATED CONSTRUCTION COT: f and aalae oP toi(Please round to nearest dollar) "■ —I. —I- '� �� . 5. ' = <br /> , <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies '✓No (Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes �jNo fDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? _Yes VANo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes EiNo <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 [0(\lo ODon't know <br /> 7. Is this to correct a violation?- Yes 113No <br /> • <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) --0. -0- -I. <br /> ( ) . <br />