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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT#o'1Neb App#'. <br /> pRDPERTY OWNER INFORMATION'-Z., :^a- - t N „ _F,. CUSTOMER TO PROVIDE <br /> OWjJF�2 NAME »_. <br /> 'Zoning Status; CUP; <br /> OWNER ADDRESS (Number,S¢eetOffP p) Deed Restriction; CSM <br /> �_ KKI, Variance(# ) <br /> HOM PHONE CELL PH EMAIL ADDRESS • <br /> e RAlt. FC-lan drawn to scale <br /> _AGENT INFORMATION = `-CONTRAG?OR INFORMAT-IbN.�. ( t` and i ludes dimensions <br /> . ._ ter._.;�.�- -�... <br /> AG 74c Kg.r ev I // . CO CIOR NAME /f <br /> lc-42e Hv 11414 / JIG ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se•tic <br /> 33 l E•'c24 5 t <br /> (City,State,Zip) (City,State,Zip) / El •acks <br /> h'4/A ,4 /cQ &u/ <br /> PHONE PHONE / O Site n proval from <br /> i)"C 6.5O appl township. <br /> E-MAILADDRESS E-MAILADDF S— / n 64/Cat( P• <br /> T,/rJ rrLt �4J ILt.'/IO'-` r plans to scale <br /> �.- - ,.,,- - fir <br /> PROPERTY/LOCATION INFORMATION:''Ntt•.Qaceessdane co:dane v+tiius ter Ele ion of property <br /> ENT /PARCEL NUMBER: CURREN ZONI G. t� •CREAGE: P P rY 5. <br /> NUMBER •+ �����_'4a�yyU � �� /`s nta drawn to scale. <br /> TOWN HIP: SECT4J: <br /> qtf(i►. rr Fi 1�C� �'f A: �� '/a'/a: riveway permits 4. <br /> ADDRESS* (state,county <br /> 1O �� OT M 'J 10 r anitary permits <br /> CSM: LOT ;,QNI O• BLOCK/LOT <br /> G��.n, /`` <br /> r / r (Public,- <br /> ; <br /> PROPOSED.PROJECT INFORMATION - := . STAFF;REVIEW <br /> PROJECT DESC&TIOLf r ` TM <br /> ning:Dlstnct - ` <br /> his project is a new building or structure. l r t a w <br /> P rmltfed,Use? zt 1 -, <br /> ❑This project is an addition/alteration to an existing building or structure. ,, x <br /> SANITARY SERVICE: PERMIT NUMBER: _ c <br /> f EWER EPTIC 13�- n/-7_a(3 1-G S �` ,Isting) - TJ= <br /> HEIGHT IN FEET 1 NUMBER OF STORIES: (Not including basement) ' <br /> �,S 1 ws �`�� / D�VVetland/Floodplam/ _- <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) , i <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) Y t , _ <br /> BASEtMENT: 1ST�LOOR ® Erosio l::,• j OI mit <br /> g�1-5 6 i/ '''L 4, TOTAL SQUARE FOOTAGE: ,, : slopes •Isturbance <br /> 7 r fllm• ce ss <br /> 2ND FLOOR 3RD FLOOR / / �!za tr. ak r <br /> ftevle catlop Survey - <br /> ESTIMATED CONSTRUCTION COST: �' �.y :.4'..--;-'-°-2r..-..5''nd av Iable options` <br /> (Please round to nearest dollar) --► --► ♦ ♦ ♦ -► $5 Ib LA..JO ; . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des [Z o NnQlow <br /> 2. Is there a wetland or floodplain on or near the property? QYes to ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes WNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - [Yes [ I�lo <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 n6lo ODon't know <br /> 7. Is this to correct a violation? OYes EN. <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ♦ -0. <br /> 545-112(4109) <br />