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. -.7. eq-c, .-2•d . <br /> • 'Elu• `EME"' #o web App ZONING PERMIT APPLICATION wwu .countyofdane.com <br /> 'rROPERTIt OWNER INFORMATION; r `� r w' x <br /> =�—� ..�--.; ._: :, � ,-� �_�� CUSTOMER TO PROVIDE <br /> OWNER ME �' <br /> _�Z/)( 0 . ` Ag4Aj/LLU <br /> Q Zoning Status; CUP; <br /> OWNERADDRESS(Number,Street,City,State,Zp) if i wi S ;S S�' Deed Restriction;CSM <br /> /�S C iv7 //c) c/4).1 r frtr c-In— Variance(# - ) <br /> HOME PHONE CC CELL PHONE G07 . E-MAIL-MALADDRESS , r L <br /> q ^ 9y t{ "3G 2• ,- r: / , )o S,bC-/ ,0 la ['Site Plan drawn to scale <br /> . AGENTINFORMATIO N: _ ; .CONTs_ACTOR,INFORMAT.JN a_, S`.,- • and includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME - <br /> . ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> • <br /> (City,State,Zp) (City,State,Zp) ['Setbacks . <br /> PHONE PHONE ['Site Plan approval from <br /> - applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> ['Floor plans to scale <br /> PROPERTY/L'0CATION;INFORMATiON ,(http//accessdane eo dane wi u gml.: <br /> PARENT P RCELNUMBER ['CURRENT ZONING: . ACREAGE . _ Elevation of property <br /> IllPARCEL / frontage drawn to scale. - <br /> NUMBER Do/1- S J'') S�?6•-� / J A-C..214--5 <br /> TOWNSHIP: SECTI <br /> nJ / �� 1 2 1 A— %a //4 1:1]. Driveway permits <br /> ADDRESS:y - (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED_PROJECT INFORMATION +:, '�"'rSeA \[IEW <br /> • <br /> - 5.:, r � ' =-' : � <br /> -.PROJECT DESCRIPTION: - ? ;•� '- -�-� <br /> f =Zorn gsDi`sErictri4X <=_ <br /> Is ro ect is a new building or structure. 1pY . :,^ <br /> C P 1 9 - ..rraitfe. Use? t-- <br /> This project is an addition/alteration to an.existing building or structure: 4-_ -' A <br /> SANITARY SERVICE PERMIT NUMBER :Rural:Address i4�:.Y <br /> �EwER PTtc 7-nit7ep ti g; _ ''44;zk'A' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) l�, <br /> Fri- <br /> ��e a d/ (404117442-,-,..2-77 ::-It <br /> Shorelan q a chment)? <br /> AREA TO NEAREST SQUARE FOOT: P e-- 7 �; ? 4' <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) s'.=„ 4s-__ '�k r - <br /> rosiootontrola its=-- <br /> PECm <br /> BASEMENT: 1ST FLOOR: �" �"`:�����.- <br /> p ' 4.TOTAL SQUARE FOOTAGE• 4, ' SIOpeS IStllr arlGe,°' :Y <br /> _5 G - Mfirl g,acc ss ;Z: <br /> 2ND FLOOR: 3RD FLOOR: �^ ( . •' 3 {s'"-5 <br /> o`J :07.---_ _ r � hr r ; <br /> ReYi '4 o atioa;S eyy-r <br /> ESTIMATED CONSTRUCTION COST: �, $ and alb e op otis = <br /> (Please round to nearest dollar) ♦ -+ ♦ -+ ♦ $ .tom` V 00 . . ='{`rl —_ `i <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes []O ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> gy, o ['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? - es ONo <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) QYes . ' QDon't know <br /> 7. Is this to correct a violation?- Dyes <br /> APPLICATION MUST BE SIGNED <br /> - (Continue on B ack) .-I. -► -► <br /> 545-112(4/08) S <br />