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- ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION OFFICE;USE ONLY• <br /> OWNER NAME <br /> 1MR�IC JL AN1� D '� � ` <br /> MA►-VI"") <br /> zQning E?IStriict <br /> OWNER ADDRESS (Number,Street,City,State,Zip) i0414131 --:N� g <br /> 3�Sb J� o ( .i 9CC ILO ws. S 3 S 1 I ° ° <br /> J4 a f eFfTt e <br /> PHONE E-MAILADDRESS z <br /> Zoning Status,C[JP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction; CSM <br /> AGENT NAME CONTRACTOR NAME <br /> JS <br /> tit Cld w�1"I"r :1 � ri 9Abi '` :54 )� <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 1l b N- k—°b" u� . Plan drawn to scale; <br /> (City,State,Zip) (City.State,Zip) a. ° CI.. i4JAQtenMOWS <br /> O�2Ftao WT. S 3$3J e - ,� <br /> Fitt% *ko t�dlrtgtfmoton° <br /> PHONE PHONE °'w <br /> c00% - '1b�— �35� I�cB-ZIs-gL� �® � w� � <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS r" �`°� xx 4�' <br /> Scrtrti 1 Tj�l-DrLS �' /�► • e-aM'� � s ' <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.. ) Site n pprov from <br /> PARCEL PARCEL NUMBER: Z ING: '��'� ACR E: std shl� <br /> Li NUMBER l �/ l -� ; <br /> PARENT <br /> TOWNSHIP: SECTION: Y 7 _ _ '' <br /> [)�_ l� 0 !J E /a: Ni..E /a�/a:SbC - t]CS t ing) ; <br /> ::�� e" °' Ising x ��� <br /> ADDRESS: t ; °, <br /> CSM: LOT SUBDIVISION BLOCK/LOT M jr Q plans s <br /> 'm0 <br /> e tatlon f proper <br /> PROPOSED PROJECT INFORMATION : ;yta :drawn • tscaie <br /> PROJECT DESCRIPTION: , .< <br /> a <br /> N Project . fivr a = = <br /> This project is a new building or structure. 1 sta e1 7 4 own <br /> CI This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑SEWER SEPTIC 7 -, �: :t' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) x 4 <br /> > I �ltletlandPl dtai { <br /> / `Sh€re '. attacl meat ' <br /> AREA TO NEAREST SQUARE FOOT . ,010 z.. -•. x. <br /> i. (Outside dimensions including unfinished area,attached garages and above grade decks or porches) "b . w r ' <br /> �fo�t�n trol?�perrrtlt w <br /> BASEMENT: 1ST FLOOR. <br /> • "-.. • * l" . <br /> S- -9 <br /> �3 ,+, TOTAL SQUARE FOOTAGE: 4, . -- �0Pe ove.,, l�,t7ance r^,�`- <br /> , I' a oS 3a lttlln cs <br /> 2ND FLOOR: 3RD FLOOR: ` T % ..: �, <br /> Reytevt t_ot afion Survey <br /> ESTIMATED CONSTRUCTION COST: Q� ` o to ' Y <br /> (Please round to nearest dollar "� . ' ♦ ♦ ♦ .p 3(p0 i DOO• and aft #) O ttt31S <br /> H So <br /> 1. The property <br /> • •within 300 feet of a stream or 1000 feet from a pond 4o lake? ❑Yes �No ❑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 ❑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 V No <br /> ICA MU BE SIGNED <br /> 545-112(1108) <br /> (ContAPPLinue on TION Back)ST -+ -s -►' <br />