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k1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> • PROPERTY OWNER INFORMATION s s <br /> OWNER ME[� / � ,� <br /> 1 Ia /e e1 t 1{�� � <br /> OWN RADDRESS (Number,Street,City,State.,1;))) ., u <br /> 1 (i)c)e-S 36"-- lic PHO E E-MAIL ADDRES <br /> g 9 -- a �K Lad er5- ie.,. CC)/11 J <br /> AGENT INFORMATION CONTRACTOR INFORMATION # <br /> AGENT NAME I CONTRACTOR NAME '' <br /> AGENT ADDRESS CONTRACTOR ADDRESS J ark <br /> i/3k rnc)s� S-7— K s <br /> (City,State,Zip) (City,State,Zip) <br /> C ea up,-- Darn t.31 S3976 ?a-,=„.-. :,,-- --,,,,..-0„..,,,, <br /> PHONE PHONE sa e r' <br /> c q �� <br /> 2.0 - g -4 - i I- - . g <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us!) 4 fi <br /> � <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> I� PARCEL c <br /> NUMBER 11'©.7 y'— ')7 L it?' • �J <br /> TOWNSHIP: SECTION: - <br /> 60 Grove, 41/4. <br /> ADDRESS: $VA <br /> ;D�is* <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> t <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ' <br /> PooL <br /> _� <br /> { <br /> ❑This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: T PERMIT NUMBER: p <br /> SEWER ❑SEPTIC �+� <br /> y <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) { " i <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) is � �. � <br /> BASEMENT: 1ST FLOOR: t TOTAL SQUARE FOOTAGE 4, - <br /> 2ND FLOOR: 3RD FLOOR: ♦ 65-0/ {-�^� <br /> ESTIMATED CONSTRUCTION COST: r}CT � <br /> (Please round to nearest dollar) ♦ ♦ ♦ _p, _o. .5, 02) � , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes d o ❑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? Yi Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ❑No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -i <br /> 545-112(1/08) <br />