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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER DAME <br /> vt Ck�c, C� ►-�� Ct as <br /> �.� �.v A V ❑ Zoning Qjsfnct <br /> OWNER ADDRESS (Ni) ber,Stre t,City,State,Zi -. .1 t,ii v�7 v o� ( .�1_ ,: `� `�Permitted Ilse? = t <br /> PHINE E-MAILA DRESS <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;N SM <br /> GENT NAME ONTf3ACTOR NAME <br /> I sl. . _ . . . 0�. . Va- 1. I di !. VII, �. . Iii = � ` <br /> A N AD' ESS CONTRACT*•ADDRE S <br /> Site Dia graven td s aley <br /> L IL �, 1 _ S + .lA and Includes-dimensions <br /> (City,State,Zip) ,`1 �'}+r Zip) s 3 y4 ' : <br /> ��It(PI�1'3 cfitding ItfC2tlorl <br /> .* .welll/sepfic <br /> PHON_ E `1 4�CJ� P is . rums gF x2 <br /> E-MAIL ADDRESS l_ J`C� <br /> -MAILADDRESS <br /> 4 a AA A.: . I . IIII 141 - --4--' •PROPERTY/LOCATION i::FORMATION (httpa/accessdane.co.dane.wi.ss/) Site.elan approval from <br /> PARENT PARCEL NUMBER: ZONING: T- 4 a )i cable.towNnsttip A' ,s <br /> ❑ PARCELt _ K . , <br /> NUMBER ;� ��J „_ *r T % f * - s <br /> TOWNSHIP: SECTION: /'` ` �, .J.i <br /> y� i .a ress <br /> -1(51,c1 —0 <br /> �.A' vY l ;'llv , oJt t - '/<: fir►` '/<'/n. . ew/eaclsf[n9 <br /> ADDRESS: \ • tt- . ,�,v g ._- x F <br /> C!b . ). — • '/I r l _ ] _ a `Floor plans to scale A <br /> CSM: LOT S BDIVISIO� ■ BLOC q •T ' =r �: <br /> El /atlo0 of prop*prty <br /> PROPOSED PROJECT INFORMATION - frontage drawn to''scale <br /> PROJ T DESCRIPTION: : '"* .� <br /> c � pr a ,l%.Q S.r31/ Drive perms * �_ <br /> This project is a new building or structure. � S a COl 4J*town : <br /> W <br /> ❑This project is an addition/alteration to an existing building or structure. - . s '� -A I° <br /> ❑ .Saner� .ennits * <br /> SANITARY SERVICE: PERMIT NUMBER: t1(pt#bliZ'o at e'" <br /> ❑SEWER ❑SEPTIC 4 ` r ... .,. <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) WetlandiFloodplain/ ti <br /> Shoreland, atttdc 1R''e t <br /> AREA TO NEAREST SQUARE FOOT: ;� * ,"; <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) a, <br /> - Ero:;ton p trot>470:7`, <br /> BASEMENT: 1ST FLOOR: SIQe �istrtiace <br /> l TOTAL SQUARE FOOTAGE: j0 �, a a <br /> �- f►llintglapcess) , . <br /> 2ND FLOOR: 3RD FLOOR: , <br /> R y w.L�ocatl°ori Suave <br /> ESTIMATED CONSTRUCTION COST: ♦ .4. ♦ ♦ ♦ _o d� and a I8 I2 optons <br /> (Please round to nearest dollar) •P <br /> r _ <br /> 1 The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ` No ❑Don't know <br /> 21.. There is a wetland or floodplain on or near the property? ❑Yes A No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes 'I% o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes f *No <br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# ) (leave bl k if none) <br /> 6. Is a location survey required? ❑Yes No ❑Don't know <br /> 7. Is this correcting a violation? • ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) =► -► -9 <br /> 545-112(1/08) <br />