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1 k3 <br /> ZONING PERMIT APPLICATION www.countyofdane.cotll U LEMENT#o 1Neb Ap# <br /> 'PROPERTY owNER•INFORNIAnciNM •� -° CUSTOMER TO PROVIDE <br /> OWNS NAME <br /> fr4A K -ice �� 4v ' -6r enN 3t-r • <br /> []Zoning Stat ,CUP; �. <br /> OWNER ADDRESS (Number,Street,City,St e,Zip) Deed e lotion; CSM <br /> • -1 42-00 pG l< C i r LL-c-_ Varianc (# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - - <br /> 60$ '3 3! . 2•g g ripe trrSe - nail 1<gr4 ,CLIN► <br /> Site Plan dra o scale <br /> AGENTINFORINATION -, CONTRACTOR INFORMATION;: '- _ Sri- and inclu dim- <br /> imenions <br /> 'AGENT NAME t� CONTRACTOR NAME i <br /> 5 4.c� I r �y�t h S 5 4- P. Re/0 Ock2��i�S 111 Site PI�i udi ng location <br /> AGENT ADDRESS i CONTRACTOR ADDRESS of welUsi�ptic <br /> tS 25 S 51-0,/b kh�n '5`t✓k<- <br /> (City,Stale,Zip# (City,State,Zip) ❑SeV CS ' <br /> Alb:keit5c,-n GO L <br /> PHONE, PHONE []Site Plan -•p •A. . • <br /> . Q q -- 222 Toyy 3c1,'✓l� applicab;, • Ii. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> SC O 1 — 5rrtM 0LL)1 ,CO AA S4 M ❑Floor plan scale <br /> `PROPERTYILOCATION-INFORMATIiN (http/lccessdane ca lane vtti use ,. []Elevation of r erty <br /> PARENT PARC= NUMBER CURRENTZONIN : ACREAGE <br /> [I]PARCEL 0 r frontage dra to scale. <br /> NUMBER V .1° I �j ( * �"1. �� g• <br /> TOWNSHIP: ScCION: <br /> 5`pr�.geeL6 <br /> %: %%: ; []Dri <br /> (stavteew t s w <br /> n)ADDRESS: <br /> 2 6 54K Li n CL& . []Sanita p its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, ate) <br /> .PROPOSED PROJECT INFORMATION .;- ` t-tio r - 1[IEW $2P= <br /> PROJECT DESCRIPTION: itgkl s>m- 4 a 14+3 ` . <br /> . ❑This project is a buildin r structure. �- - �• F.e�ITal �, se? �1� <br /> OThis project is an addition/alteration to an existing building or structure: �� ,�_.._ : s:?_.r-, ,. <br /> SANITARY SERVICE PERMIT NUMBER: "l=J=f,tufal,A0ii Ss, =w}X .. <br /> IEWER r- EPTIC (new7e� •?-,f s=. a g <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) "-^= -'•• ' , : 4" _-F. <br /> ▪ lfetlar d/FI o 1-/:Et .,..r • <br /> AREA TO NEAREST SQUARE FOOT :Srh lan T achment} <br /> . (Outside dimensions including unfinished area attached garages and above grade decks or porche§) ,-.I�. t --�▪ � '. : �, -4.f7, 77...7.--. <br /> u,-Erosion-Con or- It",- -- <br /> BASEMENT: 1ST FLOOR: ° T� <br /> 4,TOTAL SQUARE FOOTAGE: + _ slope_s IS ante w _;; <br /> 2ND FLOOR 3RD FLOOR is c $I act ss• 4� ; <br /> Revle # •� a-----s-e-,-.i.-:.-,, <br /> ESTIMATED CONSTRUCTION COST: ob ' 'and,a `v 'a• �s' - <br /> (Please round to nearest dollar) ;,; 1; ,� a - _:t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? []Yes IEK QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? []Peso []Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Eres []No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - []Yes I Flo <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 • alb []Don't know <br /> 7. Is this to correct a violation?- []Yes Hr1-6- <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) .♦ —► —► <br /> 545-112(4108) . <br />