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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION OFFICE-`USE O LY , <br /> OWNER �� <br /> OWNER ADDRESS (N�u r, eet,City,S ae,Zip) Z9nIR�2I 0#191 U I <br /> PH j1i r 61/9 ' sv 0� E-MAIL ADDRESS <br /> r � 1.- � � ' <br /> Zor mg Status,' uN, <br /> AGENT INFORMATION CONTRACTOR INFORMATION r <br /> AGENT NA C NTRA TOR AME <br /> i 1/45 ENT ADDRESS CONTRACTOR ADDRESS �' <br /> �/ 4IJU 1/-7"�f�!v ����#�-lean drawn to scale; � <br /> (City,State,Zip) "�" '� � it;includes dimenslions <br /> ( X p) (City,State,Zip) r <br /> PHONE Q l l�/7 �j 5' '_b ‘0,47:-•-",:'-:',1 o Ing location-16 PHONE ® , '� �, <br /> r <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wLus/) ,Sett' lan air.royal from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: tli j.. . <br /> PARCEL WS-75.3 .si s I'iSFtlp (� <br /> NUMBER ". 1 <br /> TOWNSHIP: SECTION: ® a IR �; <br /> ��: 1/1�: `� ,�� �.. <br /> Ue- . ISt[kl <br /> ADDRESS: / 'N ,f _ <br /> •• <br /> _ �/OS Q14‘'CL. /: CS�7 4, r s <br /> CSM: LOT SUBDIVISION BLOCK/LOT " b � 0 5tycF� ' <br /> PROJECT DESCRIPTION: <br /> /6xA4 de„..-, � Ya <br /> • <br /> This project is a new building or structure. t , s ag n F <br /> Li This project is an addition/alteration to an existing building or structure. ,,,14.:,', � P'' :. <br /> SANITARY SERVICE: PERMIT NUMBER: ) 1 ® �� 5 <br /> ism aT a S <br /> ❑SEWER SEPTIC kt :3 <br /> HEIGHT IN FEET �` NUMBER OF STORIES: Not including basement) .z/ e �. ( s �111"etlan#1P 6640.lat�n/ <br /> / r- fr <br /> :SIlQ a1®Ae-#t <br /> �z <br /> AREA TO NEAREST SQUARE FOOT: -:::"Ni <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) rosionControlpermi • <br /> BASEMENT: 1ST FLOOR: 32_40 <br /> (? tlU�� = y / <br /> ,1, TOTAL SQUARE FOOTAGE: j h <br /> 2ND FLOOR: 3RD FLOOR: ! <br /> ESTIMATED CONSTRUCTION COST vi-RevielK k�- 1.1.f Survey <br /> ♦ -► -► ♦ -► -♦ �]/� f and a a la�e optlt�ns <br /> (Please round to nearest dollar) V 1/ U , , x <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes L�J No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'No <br /> 5. This project is associated with arezone/CUP/variance (petition/appeal# ) (leave blank i none) <br /> 6. Is a location survey required? ❑Yes �N ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes I�No <br /> CATION BackMUST BE SIGNED <br /> (Continue APPLI on ) =;r �► <br /> 545412(1/08) <br />