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spPLEMENT#o fAeb App ZONING PERMIT APPLICATION www.countyofdane.com <br /> _ ROP RTY OW. ER INFOR .>. . .. ''a� ,',-_;:,4--''. <br /> CUSTOMER TO PROVIDE <br /> OWNER DAVE 4 <br /> Q e- �r <br /> C 6 1. r�� 4 C oning Status; CUP;OWNE - 's t c; State, n � Deed Restriction;CS M 1 /-t D s Y— w a w/ e G i <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 1 <br /> - 53c/00/4 `Z gAre., •C5 t.�((//' ft ite Plan drawn to scale <br /> AGENT NFORMATION ,`., CONTRACTOR .iiFORMATIOICAC `_ and includes dimensions <br /> 'AGENT NAME /� + CONTRACTOR NAME <br /> � • A/'f ,'-e • .52I"A € [ Site Plan including location <br /> AADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) "Setbacks <br /> PHONE PHONE E6te Plan approval from <br /> - applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> • [Floor plans to scale <br /> 4ii VI <br /> ;P.ROPERTYlL'OCATION INFORM ATION (littp//accessdane co_daneyiti us���� , <br /> PARENT PARCEL NUMBER: 1 CURB TIZONING: ACREAGE _ Elevation of property <br /> - D N PARCEL UMBER <br /> �� - J chi J �i��-(1 / L frontage drawn to scale. <br /> TOWNSHIP: SE TION: - <br /> 0/a.. Zvllgv!%f' %4: t-� %Y4: [)�riveway permits <br /> ADDRESS: (state, county,town) <br /> 64/03 0C_Z-)" * [a8anitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> #40:0, REVIEW { <br /> PROJECT DESCRIPTION: ; Tti t1 <br /> �- f.;' •$7 ' r2 <,1�e_ .h Cc # IGCIi1 7-o fir' 0 , oningDistrict <br /> (J x y sh it` ,:,a ism; <br /> • This project is a new building or structure. 17.47=50-4rW45=.-ii_"2-'SVA.gt=11 Perms ed U• e?ik - �� , <br /> ❑This project is an addition/alteration to an existing building or structure. - -,w rr= : ke 1 . nk: :°'.=` <br /> SANITARY SERVICE ' '� - '- '*,>w i.;xrn_4,-g- <br /> PERMFTNUMBER: L KUral`Address; <br /> (EWER [EPTIC _y Cnew7exisbfig r-:; :-..:,-.:. <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ,,,,; ,-1i- :i <br /> Z/ A �6- 1 �l r Vetlarr d/Flood ain/;, <br /> v f _ <br /> -.Shoteland. attachment <br /> AREA TO NEAREST SQUARE FOOT = Yui= 3 ,:r-c:� ' ,, =�.}> <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) � Ir...-..-911.1 ..Z..-P.. ..1-.4.-i.,74 gl :v;�. air,:t s. <br /> BASEMENT 1ST FLOOR `«C rosioneontrA�_perrnitx. <br /> 3 ZOO ,+,TOTAL SQUARE FOOTAGE: 4, s p S�, I flJa�e , _ <br /> 2ND FLOOR 3RD FLOOR: `r i lliirlg cQss �h <br /> 1 ev w Locationt811-K _ <br /> =(Ple , 5.*:1 &l'"b'� ego ya ESTIMATED CONSTRUCTION COST: =:d ava e do » <br /> ase roun d to nearest dollar) ♦ -► -~ . ♦ -+ j Q OCR �T;V=sew ,l,uF=qRiitn <br /> 4 <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ONO DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? !I -s gNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? - W es DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - DYes j: No <br /> • 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i one) <br /> 6. Is a location survey required? (see reverse) • Dyes a, o DDon't know <br /> 7. Is this to correct a violation?- :Yes Dlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) .+ -► •-.0.545-112(4/08) _ - <br />