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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 /> Li L1 ({T1 'K.oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ■p eed Restriction;CSM <br /> 5S- 4 i c2i 0t-k2 110--1_ t <br /> Variance t ) <br /> HOME PHONE CELL PHONE E-MAIL ADD SS �( ,,� <br /> <23‘ 205 2,04j•2.z3`1*c 1,Is�tL cJ��k�t[ feav2jf I 'Cow B3' a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION dicjes dimensions <br /> AGENT NAME CONTRACTOR NAME �, <br /> -13ir .4/1 t rot l]I' ite Pla including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS oft.waseptic <br /> I$ 14 13o3d Ave <br /> (City,State,Zip) (City,State,Zip) IJ tba S <br /> Mali sov► INN 53704 <br /> PHONE PHONE ❑ Site Plan approval from <br /> ay C• CI Li< a lic a ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> a,exeteClLS t v o a i I•LOVh FI ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ,� Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL n�11-3& ,)o -6 A I ,e '�,c_ 4 6 rontage drawn to scale. <br /> NUMBER b A /` <br /> TOWNSHIP: SECOON: <br /> 60 -TA GI t✓ �P-D\1� S '/<: s--..v '/1/.: '■' Drive pe ml s <br /> ADDRESS: y • I <br /> h 3SsS (st county,town) <br /> 30 SS SICerL�t�L 9t/J f2 / I�(e-f�(ZLf IVD J �`' -I' ❑ Sani per ' <br /> CSM: LOT SUBDIVISION BLOCK/LOT ( II rivate <br /> PROPOSED PROJECT INFORMATION i <br /> PROJECT ESCRIP ION: /� 3 <br /> Cfa r f� t'e Q 6, r +00(c ta/ i/►'lkvlz.e -Cccav e 1ie..rs . `, , i* , <br /> This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. .„ <br /> SANITARY SERVICE: PERMIT NUMBER: a <br /> ❑SEWER El SEPTIC <br /> HEIGHT IN FEET: ' NUMBER OF STORIES: (Not including basement) " ∎°‘::.,"-1'. ;' <br /> Ca . e°�. 1 s- <br /> AREA TO NEAREST SQUARE FOOT: _` ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4, : ��.e a� °:1,, <br /> r <br /> 2ND FLOOR: 3RD FLOOR: . . <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► ♦ ♦ ♦ a ,.,a <br /> (Please round to nearest dollar) 3 e>q v, ., <br /> ..1/11e pr Fty is within 300 feet of a stream or 1000 feet from a pond or lake? ❑T�Y LNT�Io ❑Don't know <br /> ere wetland or floodplain on or near the property? �L�Y ❑No ❑Don't know <br /> ave you talked with the township about your project and are they in agreement? L►Wes ❑No <br /> Has there been a zoning permit issued for this property in the past 5 years? 'es ❑No <br /> s this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> /trls a location survey required? (see reverse) CI Yes ,❑,k Nom ❑Don't know <br /> JXIs this to correct a violation? ❑Yes L <br /> / APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112 14/08> <br />