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,ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web- <br /> , # <br /> PROPERTY OWNER INFORMATION OFFICE USE.ONLY <br /> OWNER NAME <br /> M� `,�` Litik-ck ei„A"Yarl() zQnlRg I?fSfRCt <br /> OWNERADDRESS (N4u ber,Stre t,City,State,Zi .� ' <br /> P �� ���- , r V �Y L _: 0 Permitted Use? <br /> E-MAILADDRESS <br /> ('� r� � z <br /> v 7 waa �' urn <br /> AGENT INFORMATION CONTRACTOR INFORMATION peed Restnctlon, SM <br /> •GENT NAME ONTFjACTOR NAME pan ) <br /> tit. . �� <br /> MI, I�1 1. �►� [!l • ` <br /> Al_N ADI•ESS CONTRACTSADDRE 8 �o kn. Site Plan drawR.to s ate it �',A 1 _ 1 r► . .IA x sand includes dimensions <br /> (City,State,Zp) , p Zip) 4, <br /> �_. ' t.:► _ � © bite lai ncluding location <br /> PHONE PHO� x=D rwell/septic �e„ i la —C34/4 .' -t.i--E-MAILADDRESS MAILADDRESS ” "' <br /> t � setbacks � x� ���, <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.ss/) ] Site plan.approval from cl <br /> PARCEL PARCEL NUMBER: ZONING: ppliOa�Ietownship <br /> - E <br /> NUMBER +i '� / _ -- _ �'tr K �+. � <br /> TOWNSHIP: - •SECTION: .1/4.. �� , ' �1al Address <br /> 6 tuY �1 vY T l 1' C7( Q _- ` (new/existing) <br /> ADDRESS: , <br /> Favor plans to scats <br /> CSM: LOT SUBDIVISIO ■ BLOC• <br /> •T <br /> ' � - v <br /> tilt Elevation of property <br /> PROPOSED PROJECT INFORMATION ; f rontage drawn to sc le <br /> PROJ T DESCRIPTION: - <br /> x <br /> Pr c.rYU S 1 �AYL � Driveway;permits <br /> his protect is a new building or structure. ii(sktate,county,towns <br /> ❑This project is an addition/alteration to an existing building or structure. M <br /> C� S nitaryperrr its <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> (publr ▪private) 'r x <br /> ❑SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 1/tl€tland/FloOd l�tn/ <br /> lr• Sh©retand-(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) • -`M <br /> BASEMENT: 1ST FLOOR: ,rOStOnCesskl1 pGRrllt <br /> 4, TOTAL SQUARE FOOTAGE 4, r (Slopes,Uls�t[11't7ai�Ce, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: g` <br /> 'L <br /> , -Review Location torey. <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ ♦ ♦ ¢ e and available opt ►ns <br /> (Please round to nearest dollar) •V ; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑YesNo <br /> CI Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes �� No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes �� o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes to <br /> 5. This project is associated with arezone/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 /> 545-112 hros) <br /> (Continue on Back) -► ,-►' <br />