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SUP,PL'EMENT#01Neb App:: <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> fiROPERTY OWNER'INFORMATION ___:; f_ M x:- CUSTOMER TO PROVIDE <br /> 010ER�NNAMM , <br /> ' <br /> . lV I U'W '`1C <br /> ❑Zoning Status; CUP; <br /> OWN DRESS Number,Street,City,State, ) <br /> �` i 1, v -e Deed Restriction;CSM <br /> 1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS • <br /> Cid 1.3"1'12_S • ❑Site Plan drawn to scale <br /> AGENT:INFORMATION, CONTRACTOR INFORMATION k - , ` and includes dimensions <br /> ENT NAME �ONTRA TOR NAME ( T <br /> �� AR& L J( t &"DOI LL t- ❑Site Plan including location <br /> Aci'u\t -- <br /> NT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1 S 1 C. of IL- _ `1 n C NI,/le S U V1 . <br /> (CI Step) (City, tate,zip) �° d ❑Setbacks <br /> 1 Ovk \N. 1\_„ 53-5�l5 t.�V\3,-."(N 1� J `v <br /> TONE P o ` ❑Site Plan approval from <br /> �)S(, - — 1 544‘ P O S ( ` applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> ❑Floor plans to scale <br /> `P.ROPERTYIL'OCATION INFORMATION ' htt J/accessdane co_dane`cwius K , <br /> PARENT PARCEL NUMBER: CURRENT NING: ACREAGE . ❑Elevation of property <br /> ❑PARCEL p r-_ 1 5o frontage drawn to scale. - <br /> NUMBER �6��� Z (�70(J^ 3 <br /> TOWNSHIP: SECTION: <br /> ❑Driveway permits <br /> D �1/lv■ -2_ ,/ /4 (state,county,town) <br /> n)ADDRESS:S 1 4 c\ `c`v \- <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) • <br /> PROPOSED PROJECT INFORMATION - ". " <br /> �� �STtAFP itE-VIEW 7� x{< <br /> PROJECT DESCRIPTION: n r. x� t.s sr-,x� , 5 9 �+ A <br /> yV10h, l•t in Wl� 1 1 Zoning D nct , ?li <br /> This project is a new building or structure. ,2„A-t ,.,4`., w4 - k. <br /> • ❑ P j 9 a Perfrlitfed.Use?. .g_ ; <br /> This project is an addition/alteration to an.existing building or structure. ” `-y - ��i3— <br /> SANITARY SERVICE PERMIT NUMBER ,,::_ ,+-�,'�t" ,= <br /> �- (new7exlstin,.4. s. <br /> EWER �EPTIC -z� ,,.�:�.. ,,. , rF , .� <br /> HEIGHT IN EE r:, NUMBER OF STORIES: (Not including basement) -1.�,n ', _ <br /> ��IIj/ :11 Y914)0/95$4455;t <br /> Shorelandj(attac-hment) <br /> AREA TO NEAREST SQUARE FOOT ". :'` ':K, :ylt_- ` <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) :f.�=u:Yr- ``f;_ <br /> ® EroslonControl permit' <br /> BASEMENT: 1ST FLOOR % ms <br /> s 4rfu rt ;TOTAL SQUARE FOOTAGE -� slo ,pes._cisurbance .�o <br /> ugccess K : .` <br /> 2ND FLOOR 3RD FLOOR - - <br /> k Ih.Lbeatl• Srvt <br /> ESTIMATED CONSTRUCTION COST: ♦ t ana abi o <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ Q.Q d 0 " ```k=- l 'i"°; ,s <br /> ; <br /> r <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes io ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes `,• ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes C-. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - ❑Yes 1U'"" <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# (24J ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes _aro DDon't know <br /> 7. Is this to correct a violation?- ❑Yes j — <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -I- <br /> 545-112(4108) <br />