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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ill a,u^' LL L ing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Eri-d I k ()c.krhv(._,..4- b,' . f cI sr-.ti r 011 53-)17 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> tic 4S 4 jt S 4,1-C_ Q Sit including location <br /> AGENT ADDRESS CONTRACTOR/ � <br /> ADDRESS / of p <br /> / <br /> 5L) rr h%ykti.e ea c 3 S <br /> (City,State,Tip) (City,State.Zip)) �-7 © (backs <br /> JPHONE PHONE /ru i rt,e ,/r-)2L S3•, !b rl S' approval dal from <br /> AO F---2,91 -7 -g `�9 pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS Jj <br /> t.locx/ 11 k 5 a l l c.rn o f laFjo plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:?accessdane.co.dane.wi.us,') <br /> PARENT PARCEL NUMBER CURRENT ZONING: ACREAGE: O Eleva 4,. •f property <br /> PARCEL El � fr•.••.:,,- drawn to scale. <br /> NUMBER C ?(�ZS )S3 9 o n n - ' <br /> TOWNSHIP: SECTION: <br /> t "el '/.: 1/4 1/.: O Drn l <br /> Aooi <br /> tss: _ (state nty,town)`'I <br /> L/0 l L I ea Se,,,..-"/ Ve Rel t O Sanita its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (1w. -te) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRO.ECT DDESCRIPTION: �^ / _ <br /> !)ec k /,:. lento p g.x 0 .4- 6'4.i r. 4 i mid <br /> . [This project is a new building or structure. Drt Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER CI Rural Address <br /> R rIEPTIC (\/ (new! .. ■� <br /> , <br /> HEIGHT IN FEET:' NUMBER OF S S: (Not including basement) <br /> I ❑ w::, .,'Z...i-, � Y ) <br /> AREA TO NEAREST SQUARE FOOT: j -1,11. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> • • • • it <br /> BASEMENT: 1ST FLOOR__ <br /> ( <br /> : <br /> 4 TOTAL.SQUARE FOOTAGE 4 , a •; •- <br /> 2ND FLOOR 3RD FLOOR: <br /> /3-G a . . . Icy <br /> ESTIMATED CONSTRUCTION COST: and ava ablle <br /> (Please round to nearest dollar) "• "♦ $ R 000 <br /> r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes alo [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes Do ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes [}lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? la es alo <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) aes [3 o ['Don't know <br /> 7. Is this to correct a violation? [JYes I '° <br /> APPLICATION MUST BE SIGNED <br /> tti2 tine) (Continue on Back) -. -. -► <br />