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zS1I�LEMENT�1b�1Ne6�App°#s <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OINNERINFORMATIME _r_„t :1'Ug4 - - ; CUSTOMER TO PROVIDE <br /> OVEa- NAME <br /> `KIP,. ; /e u ViZoning Status; CUP; <br /> OWNER (Number,syeetcazP) Deed Restriction; CSM <br /> J K O Variance(# ) <br /> HOME PHONE CELL PH EMAIL ADDRESS • <br /> e Plan drawn to scale <br /> AGENT -.- �_,-. ;AT CO NTRAG'[O_R_yINFORINATION. � _ `-. and i ludes dimensions <br /> AG NAM�w l / CO C OR NAME <br /> C- / ( ev, ! 4 / R N e w IJ4 / )-(G ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se tic <br /> - <br /> 33/ 5'''nom g r <br /> (City,State,Zip) (City,State,Zip) aCkS <br /> ZIA /A.,4 !." -1, iiI <br /> PHONE PHONE n Site n proval from <br /> e ,--G65.4`' appl township. <br /> E-MAILADDRESS E-MAILADD S /� • <br /> . -JE/�/�euife64 r plans to scale <br /> PROPERTY/L'O_CATION INFORMATION (littp//accessdane aod_ane w�•iu ) .J <br /> -PlrENT PARCEL NUMBER n CURREN ZONII G: of CREAGE . Ele ion of property <br /> aiFicEL 65.NUMBER 6������o��yU �='I A . / S nta drawn to scale. <br /> TOWN HIP: ^ SECT 1:: <br /> gt if IA i F C 9 �f %4: .\--f WA: riveway permits E <br /> (state,count” )() <br /> ADDRESS- ��_ ) A f� S+ D � <br /> CSM: LOT #IJQ�wIO∎ F� BLOCK/LOT (publ cry permits ,• <br /> PROPOSED;PROJECT INFORMATION-''`- ' ` '..t4'7.0. '' E <br /> �:� _-.� AFF RE-�[IEW <br /> PROJECT DESC PTION: =�Ei s n Y c+ <br /> t �'��— Y riing Dlstrlctw <br /> hIS project is a new building or structure. '�* ,4-' `"3� � 5 <br /> P rmitfet Use?, ,2 <br /> ❑This project is an addition/alteration to an existing building or structure. _ ° T"- r _ • , <br /> �`` ` � itAte. x � ter. <br /> SANITARY SERVICE: PERMITNUMBE2: "'- .4 'Y • .4 s:.;; <br /> �(''-'7p_EWER � '-5 TTIC 3,� rew sbhg). ` s. <br /> I 1 1 1 I "1 �tJ Q 1��S ?Y .''.✓^:, 7 t' 2. ss'hi <br /> HEIGHT IN EET: NUMBER OF STORIES: (Not including basement) x <br /> '"4■� l 1 =® GVetla d/Flood IaIrU • ' <br /> S ti Ote l a n d'catt a c h rrl e n t) <br /> 7/ - • TO NEAREST SQUARE FOOT �F 14z�-,� - 4 <br /> (Ouside dimensions including unfinished area attached garages and above grade decks or porches) 'r y` . _ A •'r <br /> _� Erosio C•' 1 of pErrrllt ` <br /> BASME 1ST 00 2 :-i .`S-- I a.(1-..a 7, <br /> 4, TOTAL SQUARE FOOTAGE: ,+, v��SklOpeS�Isturbance <br /> 2ND FLOOR 3RD FLOOR --Its.r cp .SS �« <br /> e •cati.n;§-0 <br /> 46y V46y <br /> ESTIMATED CONSTRUCTION COST C 'At �' _ and av labfe opt onsk <br /> Please round to nearest dollar) aV COQ'//�d'''' <br /> r sz..4..... <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? yes [ o <br /> D o naow <br /> 2. Is there a wetland or floodplain on or near the property? Dyes to DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes WNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - DYes 1E0o <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) DYes lo DDon't know <br /> 7. Is this to correct a violation?- DYes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ - -I- <br /> 545-112(4108) <br /> • <br />