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ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> TOrtn. 1 EM 12.1 TE ❑Zoning tus;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) De estriction;CSM <br /> 2.2b3 F4AMI konjD ROAPIC700601-0M) WI 535$1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ig- 33S-8609 ii k(reIned le f Steglobal, lid <br /> 0 SiteVia<rawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -PE ve i AI E 6 I?O U P LO&i pp$J L U M P,ER ❑Site Plan incliwing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/,Septic <br /> N 421's SCHIi-f-i/V E&Uf1D ?4- j p - STREET � <br /> (City,State,Zip) (City,State,Zip) ❑Setl` ks <br /> hit?/ Wft-TER, ii 63110 CAmBei DGL, WI 53523 <br /> PHONE PHONE ❑Site P al from <br /> I • BOQ- i - 2 g20 (fog- 423- 3316 applic: t ow ship. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ❑Floor plagto scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevatio roperty <br /> PARENT PARCEL NUMBER: CURRENT ZON�II�`,G: ACREAGE: <br /> ❑PARCEL A"l . 4 30 I l Q frontage rawn to scale. <br /> NUMBER ��// <br /> TOWNSHIP: , SECTION: <br /> bUfll K11U( '/.: WA: ❑Drive a rmits <br /> ADDRESS: (statf ��'�"" 'own) <br /> 2 z 3 Ii-A-m.voto Rom' , s7UOb t1'fOi11 NI 53589 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑(pub i, •(- -)• <br /> PROPOSED PROJECT INFORMATION F <br /> PROJECT DESCRIPTION: , <br /> p.A1R.Li t+EIFER $litfLL kr C1- nga � <br /> • ®This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural m-"-4d <br /> EWER FTEPTIC .lt,`t °t <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ` j ' <br /> o ' , MOM) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) PV1 Eros BASEMENT: 1ST FLOG r " <br /> 1d 0e — �, TOTAL SQUARE FOOTAGE: 1 (�s - r .ff .s r <br /> ea t o cic°'_ <br /> 2ND FLOOR: 3RD FLOOR: 1 0 0 8 0 <br /> (Please round to nearest Cdollar COST: $ 2_2r, l and '; ,,!'t% <br /> ESTIMATED _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes `4 o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des No <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 OW ['Don't know <br /> 7. Is this to correct a violation? ❑Yes YJNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />