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'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION OFFICE-USE ONLY <br /> OWNER NAME „ ` t <br /> e)4PI 0- ,r7 Sc- „ -tZ. <br /> zoning Dlstri t <br /> OWNER ADDRESS (N4umber,Street,City,State,Zip) <br /> 4 <br /> a?;co- Xr S3? lI <br /> i y Re-Al ;s G r 1z >� 1C fiPermltt d'Use? <br /> PHONE �j E-MAIL ADDRESS . <br /> x T, <br /> U Zoning Status,CUP <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction ,CSM <br /> AGENT NAME CONTRACTOR NAME �. <br /> Ti Hiude �/G���t^ Spa j/ C vote bn�eS ',,l i, <br /> AGENT ADDRESS CONTRACTOR ADDRESS ' <br /> te=Afart drawn to state <br /> ° 6 ° 58 /' /5 , ° ' <br /> /� � � ,o� bay '����dricl�ldes�tlimenslons. <br /> (City,State,ZIP), (City,State,Zip) <br /> /I/1, j- o;,Qb wZ 53592 <br /> C ft% a rncudngoan <br /> PHONE PONE <br /> E-MAIL ADDRESS E-MAILADDRESS &”?�o � of <br /> ../ igWel°45RINVINInana; <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wl.us/) ,$ e Plan approvayl from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> PARCEL 052.r' t n �e Cabie`'tpwnsOIp�., t <br /> Ll <br /> NuMBER o 6 Cj 7 i z l°c� 3• .y 7 6 ���� �� l a tail <br /> TOWNSHIP: SECTION: r s ` <br /> M ADDRESS: 4 M <br /> 3/ y k 4 R • 90 '�rp§ns :illa <br /> A <br /> t CSM: LOT SUBDIVISION BLOCK/LOT . s <br /> PROPOSED PROJECT INFORMATION <br /> :: evatidn` rope <br /> frontage.L raven to kale <br /> PROJECT DESCRIPTION: �t�:tea <br /> x.e :,k4-c.., /,/e>,3'‹ i �b ve sits <br /> sae,,. town) <br /> This project is a new building or structure. . _ , i t <br /> ❑This project is an addition/alteration to an existing building or structure. � :� 4 o l ° <br /> SANITARY SERVICE: PERMIT NUMBER: a (�i13�,�akjaP <br /> a SEWER SEPTIC 5/7 eV/2 �. '3 . s"` I <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) l <br /> �I���etlafid�'Pl�odplair�1 <br /> 1 Shore(an attaohiT ent.) <br /> AREA TO NEAREST SQUARE FOOT: ` . _ madoop. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Ereslonco trolpermit{ <br /> BASEMENT: 1ST FLOOR: b1 �i = b:�1e <br /> - o 9 r z0 5// ` TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: x'a, Wi r <br /> Revie Location Su ey <br /> ESTIMATED CONSTRUCTION COST: 3 Z o vx x � <br /> (Please round to nearest dollar) '� ♦ "► —► ♦ ♦ Uo and"aattatliio trod- <br /> ( ,' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 1 ❑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 8 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ID Yes 3 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? • 0 Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ■ .4. <br /> 545-112(1/08) <br />