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1101 <br /> ZONING PERMIT APPLICATION ww <br /> w .coun`tyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> NAM � r C oJih'wilIY NERADDRESS (N4mber,4iiiy ee i y,sta"fe,Zip) <br /> ❑Zoning St tus;CUP; <br /> ,./ n Dee strlction; CSM <br /> 33Z I WI rrg /CAA . Mot &JT 4A%' %I/ 5351, Varia ce(# ) <br /> HOME PHONE CELL PHONE AI ADDRESS <br /> 9, - 1- 43,4 0,'-40-Oa n ,c nn&mA/-4• net ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR 'ME <br /> ./._.__ i .,ii / ..At 4IL OM Site a I ing location <br /> AGENT ADDRESS 0 TRACTOR ADDRESS / of w tits <br /> II i JL...!/ El$etb`� " <br /> (City,State,Zip) (City�JrState,Zip) <br /> PHONE PHONE 4 J. �I' ❑Site Plar � om <br /> I - 54 - G . applicab ip.E-MAIL ADDRESS E-MAIL ADDRESS <br /> El Floor pldito scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING. ACREAGE: <br /> 0 PARCEL - QCp 4 'Z frontage drawn to scale.CI NUMBER �� ✓ v ( ' <br /> TOWNSHIP: SECTION: <br /> 1/4: 1/a1/a: ❑Drive Its <br /> ADDRESS: (sta , o nty,town) <br /> 321 hll rTI ,b-. Maul rI/D ' too 535'74 ❑Sanitary p r 's <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,p <br /> PROPOSED PROJECT INFORMATION STAFF`REVIEW <br /> PROJECT DESCRIPTION: /� JL M A-aI 1 iN G B- ❑ Zoning District <br /> . NThis project is a new building or structure. ❑ Permitted Use? <br /> /This project is an addition/alteration to an existing building or structure. [ <br /> ❑ Rural Address i( C01/44 <br /> SANITARY SERVICE: PERMI N R: ....C\ <br /> /� 1.14.4e L EWER PEPTIC i,� A ,� 1. . (neWial, i it9 { e' <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not i luding basement) ( —✓ 2 ,-i y. <br /> }� /,� /^ f e A /ll <br /> V V ,&t.V ` AREA TO NEAREST SQUARE FOOT: S f Wit!!! ♦—,- 4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) •❑ Eros e e BASEMENT: 1ST FLOOR: OOO % <br /> Y� .1, TOTAL SQUARE FOOTAGE: 4, (SID a P; i I ;',� ', <br /> Min! .6-«_- ) <br /> 2ND FLOOR: 3RD FLOOR: n <br /> 000 ❑ Revi- e` u.,. survey <br /> ESTIMATED CONSTRUCTION COST: �/� anda ; ', - e <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ tl, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ail ❑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? gbies • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? eYes EINo <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) Des silo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0,40 <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —I. —to —► <br />