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2-32 . <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME�y+ <br /> $#e 7"f'e.S �4•atl I y�"Nsf(g/c4410P-14 1f he( ..Cie---e-Wes) Zoning Status; C <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Res ICt. ; CSM <br /> `-j s' c r Z.4 A e. Mai"so b G.A.TS 37/ t Variance(# ) <br /> HOME ONE CELL P ONE E-MA ADD t`SS <br /> C 22z-?73 g , 6o�.)z3' -87sz r 1.t 1 '41. s" '' Q `t ia/ 1• C °4"` <br /> Site Plan da to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include <br /> AGENT NAME / CONTRACTOR NAME <br /> -.C61. A Itelia Z L C I'ite PI n i luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ <br /> 3 S tac 1Z a.A <br /> (City,State,Zip) (City,State,Zip) �tbl <br /> '1a4't'so 0. G`'r s )7'C �--�/ <br /> PHONE ONE ' L� Site Plan/-•pr. om <br /> ‘O8 2 3 '- 8 2 S Z applicabl- tounsh .Lana( kg e._ <br /> E-MAIL ADDRESS E-MAIL ADDRESS C o ell n.c/ '/{F Oil- <br /> I-it C 4.44. Sys "eoS z h� f . Floor plal�fo scale <br /> ' � ��C e <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevatio of o ert <br /> ••RENT PAR _ CURRENT ZONING:x ACREAGE: P y <br /> wi PARCEL NUMBER o h o O - .z• <br /> �+ <br /> A./E ►` 5. 0/ 7 frontage wn to scale. <br /> TOWNSHIP: �Z/ SECT ON: S \ ,[,pn-� �,� <br /> Pe I^h Pr -NA s: �.F %1,��•2 o E Dr - 144- Its �'0'�'1�+-t;'1� e <br /> ADDRESS: (si' • r • , own)ok. <br /> 6 ?° Sield 441 7i5;147t4/ Pi t. HoVeb/-'''r S3S 7 2 12-snita m s g " ,7 <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public!p r-r\� <br /> /t///9 r— r <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> X'I'S ,(I'h 9 m o bit f e /ron,a fc be r enle04 h eta ,(ay fe 4 /� ❑ Zoning D ct <br /> . his project is a new building or structure. ❑ PermittdUse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER: / ❑ Rural Ad r <br /> EWER DEPTIC I 3- p�.- 0'`0 2 41 6 (new ist1 9 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2 G 2 ❑ Wetlan' l e. .* / <br /> Shore!1.1. . a. ment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1 ❑ Erosions'•r�ol permit <br /> �— ' 6 X 3 d (VS)A I + TOTAL SQUARE FOOTAGE: 1 (stool. 0 I isame, <br /> 2ND FLOOR:a Ofil7(11 RD FLOO d�— /O O / /2 / � 2) V fillip• -CteSS) <br /> 3 X30 1 ❑ Review •'b,. '•n Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ /� 0 d O o and -i : -.I=options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑1'es []No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EiIQo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Rfes ❑No La-meal ecloih, <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes OPdo amp p <br /> ❑ Y-a <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 LJ'"o ['Don't know <br /> 7. Is this to correct a violation? [Yes [ to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* <br /> 545-112(4/08) <br />