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ZONING PERMIT APPLICATION www.countyofdane.cottl `;3u �>:MENTto We # <br /> ROPERTWOWNER•INFORMATION ` .-- ._. ,--_�.. `- `_ ^ CUSTOMER TO PROVIDE <br /> OWNER NAME/ <br /> 6e/A% B 4IG7" ❑Zoning Status; CUP; <br /> OWNERADDRESSS (Numb Street,City,State,zp) Deed Restriction;CSM <br /> ‘ //i/ Ccavey lad A) B . S w1 Variance(# - ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - • <br /> • ' 1 57 /Otl/ ❑Site Plan drawn to scale <br /> . :AGENT_lNFORMATION ` `CONTRAC O0NFORMATIOd ',f „s4 : and includes dimensions <br /> 'AG ME // CONTRACTOR NAME <br /> t rk e fts ver • k• L1r5y 1 y j CAarzueT>>- ❑Site Plan including location <br /> AGENT ADDRESS CJONTRAACTOF ADDRESS of wellseptic <br /> (City,Stale,Zip) - N V I aPe i✓Px_5u.4.) R�/Pt <br /> (City,State,Zip) ❑Setbacks ;/.ti 4 �qt-1� <br /> 5iiii Pmfgde ituX 63590 <br /> PHONE PHONE {�c�/ ❑Site P .,,,,valfrom <br /> • Coo Q� 356 325-1. appli•j• e s gt -'•• <br /> E-MAIL ADORES S E-MAILADDRESS • <br /> C4TAL)67"7e/ opez*A Npp Floor plans to scale ,/ <br /> `P..RO PERTY/LOCATION INFORMATION htt //accessdane ao dane wi us '� _` <br /> ( P �3Q_ 3 ❑Elevation of property J <br /> PARENT PARCEL NUMBER CURRENT ZONING: , ACREAGE <br /> ElPARCEL r ,�3 frontage drawn to scale. <br /> NUMBER b{L/v7IIf�r7r1/ A- Iel 1D4�ecS <br /> TOWNSHIP; / SECTION: <br /> j(!SL ID J. _ ..x,.: 1/a%a ❑Drivev�yd its <br /> ADDRESS: J (state,co ty, own) <br /> 6?/1 `�� .'✓ ' ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION - r c3 <br /> PROJECT DESCRIPTION: "rs'r` , ti -Z'Y -=i-""' <br /> A/97 41 • - r Zariu,:;:t s�trict'= 4:.„, ” -<' <br /> . ❑This project is a new building or structure. <; '- 6 r :U ?> R i. �Pei=fi�aitfa?--•U ,�"�ir;•r--._ <br /> •_. '` -, <br /> [This project is an addition/alteration to an existing building or structure: *:=7,-71;r4-.7 t� � <br /> SANITARY SERVICE PERMIT NUMBER ::_=Rural Address -.z-Y;, <br /> EWER EPTIC .c,1, 1-ewSting�i-..?_F;- <br /> HEIGHT IN FEET :• `` f --- = :.{ ;'' <br /> NUMBER OF STORIES: (Not including basement) `� ""`°'�,,-'""'" '-�" <br /> IZ .r: .._ _� <br /> %tip;' �, ,.rtr. �-�c;-r.�"`==`-_, <br /> Shot eland fa`ttachment <br /> AREA TO NEAREST SQUARE FOOT ���'��,.,_•-- ,�;���.� '_w r:q:r� <br /> . (Outside dimensions including unfinished area attached garages and above grade decks or porches) � - -; <br /> BASEMENT: 1ST FLOO _ - �* <br /> roslo tiiil -pirmlt <br /> p � - `'� ' <br /> -/'70 �. o 4.TOTAL SQUARE FOOTAGE:. 4.. ''"�--- SIO es;.. istl�ri;ance :���,� <br /> •2ND FLOOR: 3RD FLOOR - "* `.{-7-5'. <br /> - ,_ •ash. ,-9 <br /> (�Ll D Re ew-Locatio T <br /> r <br /> • <br /> �S7A1y <br /> :u ¢: •. tom ? t. <br /> ESTIMATED CONSTRUCTION COST: 'may �� �• <br /> . 1 D©C7 ; --and a �il�f;fe t7ot�s,� :1,4' <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �; ., � 4;��.� - y :; • <br /> A ISb:SD- - <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 10 es UNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? • 2 es Ohio ❑Don't know <br /> 3.Have you talked with the township about your project and are they in agreement? DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - ❑Yes '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) V ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation?- Des to <br /> APPLICATION MUST BE SIGNED <br /> - (Continue on Back) .-► -+ -0-545-112(4/08) - . <br /> • <br />