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f . go ri-kG <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> D IG �� IE Ue In 1 ❑Zoning Stat , CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed a iction; CSM <br /> Co 5�0 (� �� cn I Varianc (# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> Cis 3 -5-5 i ❑Site Plan r n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME / <br /> o,r r t\P�,p / P GvS'1-c vV\S ❑Site Plan • clu•' • location <br /> AGENT ADDRESS CONTRAC ADDRESS <br /> /// of well/s= �tI• <br /> 3-7/7 `T,ka- l <br /> (City,State,Zip) (City,State,Zip) ❑Set•.•CkS <br /> PHONE PPHONwr�S 1 L.-:- 53 S Z ❑Site P n a _la from <br /> 6_,-,9 -- 5 7 - 3 s' appli 'u � <br /> "LI` ship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> �, iv, 5 c c,rr'e f, . ❑Floor la s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wii.us/) ❑Elevati n of p perty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL / -� frontag dr n to scale. <br /> NUMBER 044 _3 -c)SSSr�' 1 I <br /> TOWNSHIP SECTION: <br /> ❑Driveway p r <br /> o \ J e I a b..) ✓ 1//: //: <br /> ADDRESS: (state,coup ,town) <br /> !�5�o �'r / ti) L�vLSL_ ❑Sanita pe <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publir.pr t at'''���� <br /> PROPOSED PROJECT INFORMATION �� ,STA.F R <br /> PROJECT DESCRIPTION: �' <br /> `� � rI6 cf 'I I1 i G a( Cl zoning >rI nct <br /> This project is a new building or structure. Lents <br /> ❑This project is an addition/alteration to an existing building or structure. y <br /> SANITARY SERVICE: PERMIT NUMBER: 0 *u�Ad ress <br /> EWER riEPTIC (new 74: }1.HEIGHT IN FEET: NUMBER OF ST?RIES: (Not including basement) <br /> i(c_c.---/—' lik\11 (9 ARE O NEAREST SQUARE FOOT: Sho h1tTierft).(Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErOStOBASEMENT. 1ST FLOOR: t �j + TOTAL SQUARE FOOTAGE: + €.�-., :'!)°' <br /> "' , <br /> 2ND FLOOR: 3RD FLOOR: �/ I�tngJaess) <br /> ❑ Revi n Survey <br /> ESTIMATED CONSTRUCTION COST: �'( / and • ••iwiQnSi. <br /> (Please round to nearest dollar) "� $$ C� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? oyes irj o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes a o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? "Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No D FYI t/�,�i�ti`) <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) ❑Yes r! o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ -+ <br /> 545-112(4/08) <br />