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�SU�LEMENT#o 1AIeb�A�_#�: <br /> ZONING PERMIT APPLICATION www.countyofdane:com <br /> PROPERTI(iOWNERINFORMATION _r -- ` = <br /> -. ==-�.:.�:_, _,_._._._ -.�. _ �,•�-� CUSTOMER TO PROVIDE <br /> OWN ME //4747(-/ . <br /> " ��T7EYE_ oning Status; CUP; <br /> t/ OWNERADDRESS(Numm/rbe��r',��Street ate,LP) Deed Restriction;CSM <br /> 7- L,C___ IT W Lb Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> C8 50-8E/3_ 2-Stte Plan drawn to scale <br /> AGENT�INFORIWATI.ON- : CONTRACfOR,INFORMATIiiN ,t, Y .t`. : and includes dimensions <br /> 'AGENT E CTOR NAME <br /> '‘e_._)(2_1461,) ,tea :f CO(7ri�� -AIL ite Pian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 34 p A\' �- —�.-Av .� . <br /> (City,State,Zp) (City,Stab',Zip) etbacks <br /> /`11) e - <br /> PHONE PHONE�.-5 U [Site approval from <br /> 6- —5? - ,e - ,5� 8BFs'! -a • ab township. <br /> E-MAILADDRESS 4,-tex. .r' -MAILADDRESS <br /> e Lo QiJk' GCE Q. /-�40.l iiE, Iy jri/ y.,,qj or plans to scale <br /> 4 � � �Y <br /> PROPERTY/LOCATION'INFORMATION (tittp//accessdane ai d_ane wi lO _ _-, evation of property <br /> PARENT PARCEL NUMBER CURRENT ZONING: : ACREAGE . <br /> ❑PARCEL / j� frontage drawn to scale. <br /> NUMBER �� I I- 01-I -'d c_! A- / I ./ �� <br /> TOWNSHIP• SECTION: <br /> -1r'�TT 10 %.: S E i14: ❑Drive mits <br /> ADDRESS: ` e,c unty,town) <br /> lip C(SC2F_/ 0 ' ■ 6-4-10 fe-ja--- -e/ Y E�-.❑Sanitary •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pubQ►,priv. - .4 <br /> PROPOSED PROJECT INFORMATION r = = S A RE�IIE .. <br /> 'F F `PROJECT ESCRIPTION: s '` j <br /> = <br /> � t1 G --LC). <br /> "1/F `714. /(41 --- w/ fl i-;--.61 onog Dtri t � 1 <br /> • ❑T • ro ect is a new building or structure. : s.M1 t-g` -- g•+ 41 <br /> P 1 9 �- ..eCfra7ffirc�U:se : �--. <br /> • project is an addition/alteration to an existing building or structure: _g ,.� -- ..•• . _ , <br /> SANITARY SERVICE <br /> PERMIT NUMB Iii ,:tAi Y -: .i 5 �: <br /> EWER TIC r ; . F�'t?"• <br /> HEIGHT IN FEET: NUMBER OF T RI S: (Not including basement) -• 'w r•-.••"Tk`w --4 <br /> V61,o d%.= plat /r:r .: <br /> `Sfio` -r d l c7 trigs �; <br /> AREA TO NEAREST SQUARE FOOT: d / �' <br /> C.44w�,ry it-`• _ YFi=� '4R'�.......•F�.JC.'��. <br /> ,� Vii:'..._•-. .• � .. -�`• `. <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ..� ,,.Y4 'r,t <br /> i Erosi•-'Co-,.ol permit = ':, <br /> BASEMENT - 1ST FLOOR f, - t t;= <br /> _ j TOTAL SQUARE FOOTAGE:. 4,. s,,.__s . s..... nce oe <br /> 2ND FLOOR 3RD FLOC) LP _y <br /> 10~ °4 Review. pcatibnrii$$ivey_ <br /> ESTIMATED CONSTRUCTION COST: .Lzndavaila: oj5tons : <br /> (Please round to nearest dollar) ♦ ♦ -* --I► --I• ♦ GO k `' - M "if ;t; i`$ <br /> _. - 0 <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes illiDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Y Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Uees 6,,,r <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes <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 • [No Don't know <br /> 7. Is this to correct a violation?- :Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) .--► ■ --► <br /> 545.112(aoa) <br />