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IC111 V `( del E37 iiiiii=2223 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> lit z r &h de D Zonin Stat ; CUP; <br /> OWNER ADDRESS (4Jmber,StreetYity,State,Zip) Deed coon;CSM <br /> 531b f1thbt Variance(# ) <br /> HOME�PHON�j CELL PHONE E-MAIL A••RESS J <br /> ,o U 9q1 70 2i 9.' • in acer'r7• ko 0 4•CoM 0 Site Plan dr w o scale <br /> AGENT INFORMATION I C JNTRACTO►t INFORMATION and includes imensiontS <br /> AGENT IXAMEI CONTRACTOR NAME <br /> `�7 er Sik yde - 1114^ k--ere S' D sit uditi 1� o <br /> AGENT DRESS CONTRACTOR A,Dp RESS of well/sept <br /> (City,Stat Zip) (City,State,Zip) D Sete <br /> Soh pi to/ 533 o reite- (v/ C35-2 7 <br /> PHONE PHONE ID Site P n val from <br /> om/ JD 3 s� �S�S �O Q b o�g ��y a PP liab�shi . <br /> E-MAIL ADDRE �,. E-MAIL ADDRESS <br /> ' .� Sh /�dor& 74,1 a,,,, 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) 0 Elevation of property <br /> PARENT PARCEL UMBER: CUR NT ZONING: ACREAG : <br /> DPARCEL 0/9 07 11-2 2 3-15o0-/ ( - C x qo frontage drawn scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1/4: N '/%: SC S to ❑(state,ew y,to <br /> C9/7I� 22 -7- // <br /> ADDRESS: (state,county,town) <br /> Ii <br /> ii .ii - �_. - I) D Sa, pe, ts <br /> CSM: LOT SU: ISION :LOCK/OT . <br /> ,S/ f uJ <br /> PROPO?.ED PROJECT INFORMATION STAFF REVIEW <br /> PROJEC r• SCRIPT' : <br /> '%, /` o fe b4;r, '1D X 7 2 I ❑ Zoning i rict <br /> IThis • • ect is a new building or structure. ❑ Permitt e? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ I Address <br /> EWER r)EPTIC ,, l#i, 1 Y ( existing) <br /> HEIGHT IN FEET: r t j� BE OF STORIES: (Not including basement) <br /> 10 I g � D,Q4 K- LI Wetlan Fl odplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErO�onCont of •rY OPP <br /> j TOTAL SQUARE FOOTAGE: ,l (sIo• • - I ;-, •,� <br /> NJ : — : ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2§gC, ❑ Review L t' Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ and avail options. <br /> (Please round to nearest dollar) '♦ '♦ $ ri-06 O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elk es 0No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? `1 es [lo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? j es ow <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes 'a4o <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) Dyes ik: o ['Don't know <br /> 7. Is this to correct a violation? DYes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -0 <br /> 545-112(4108) <br />