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ZONING PERMITliOLICATION www.countyofdane.com &- .21:=1=113''' <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> se-AU.-v4- 126.13ec 1,0A-W1-1 k) ❑Zoning atus U; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Dee estric St 9c'7 <br /> aib3 £5t3VrR.� LROE 5-cov,WT 3 wt 5?>5 9 Variance(# <br /> j' <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 873 -8$73 - -5yDa ❑ Site P n rawntosc � <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and inc des dimensi <br /> AGENT NAME CONTRACTOR N E <br /> CAN 1 5 Ne0cranin 6.10/451.1 M.I 4"Zes%(S0 -Tilt ❑Site PIa in luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s is <br /> X185 Oeec cdatc t)c;vie 3M M e e r Pot,(A V i c <br /> (City,State,Zip) (City,State,Zip) ❑ Sucks <br /> STo u 6 N+-'o I J t o J S'S/ ►1 skfl u 1►I t a I.. W I.. 5 3?(( <br /> PHONE PHONE ❑Site P a pit; - from <br /> 6o8•'x"11-1131 4$-$Y1- tlt appli ,1b • n.hip. <br /> E-MAIL ADDRESS t g E-MAIL ADDRESS • <br /> CiNtj S 4a. S�Atr►�u t 141 at , C 0 M cute,.,\'.vt @ 1c yter , I\et ❑ Floork t• scale <br /> PROPERTY/LOCATION INFORMATION (http J/accessdane.co.dane.wi.us/) ❑ Elev do •�� ••erty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL //�� t �j a 3 . 57 b fron d a to scale. <br /> NUMBER t„n�7/0612 •� �$6gS'O r � _______ <br /> TOWNSHIP: SECTION: <br /> '/a: '/a'/a: Drivew rmits <br /> ChCc SN 00. (stat ou y,town) <br /> ADDRESS: [ 2 j \ <br /> �j \V ❑Sanit ry rmits ,44 <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publ. ,,emit <br /> 1`-15 3'-1 vt v VI <br /> PROPOSED PROJECT INFORMATION STAFF • - IEW <br /> PROJECT DESCRIPTION: <br /> NE.W fty1 E. ❑ Zoning -trict <br /> . taThis project is a new building or structure. '❑ Permi Se? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ F ,I Address <br /> yy <br /> EWER EPTIC 1'�- a o 1 7 - 0 0 a? 3 existing) <br /> HEIGHT I EET: `+ NUMBER OF STORIES: (Not including basement) <br /> \ ` ❑ Wetlan 1,1,...t. 1ainf <br /> Shovel. • ( - fitment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 1--k EfOS O O,. ,• rrTlit <br /> BASEMENT: 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: 1 (SIOp1- Wig,"anr-£, <br /> -7...S.CI ��� filling/a• -Ss <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 11 S ❑ Revie L''•- ,- urvey <br /> ESTIMATED CONSTRUCTION COST: and av= -.hi•oe ions. <br /> (Please round to nearest dollar) -► -0. -0., ♦ 'P 900 Q C <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres 121Nlo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es al o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es falo <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) Dies etal.o ['Don't know <br /> 7. Is this to correct a violation? Dies ilttlo <br /> APPLICATION MUST BE SIGNED <br /> / (Continue on Back) ♦ -► -► <br /> 545-112 4/08) 9-/R-/ 7 <br />