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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION OFFICE:,USE ONL"Y <br /> OWNER NAME " , <br /> 13144„2_ � aB "" / 9 ' (Pct �; �.p�, �E D <br /> OWNERADDRESS (Number,Street,CYt J►� , I g ©tstt-►ct <br /> y,State,Zip) Vv � <br /> 1 <br /> '7o a P0� FU .B"/ e'ZA ` • �3 3 a Per'rr Itt�ed Use? <br /> PHONE <br /> E-MAIL ADDRESS t ti <br /> V <br /> oo8 &' - - i 3 ' <br /> Zoriing Stafus,CW, <br /> AGENT INFORMATION CONTRACTOR INFORMATION per Restrction CSM <br /> AGENT NAME CONTRACTOR NAME . _ <br /> n`apce <br /> AGENT ADDRESS CONTRACTOR ADDRESS .F <br /> jte.Ptan drawn to scale: <br /> &fn.,/ OA <br /> �'. �dirtclLldes dtmenslons <br /> a(City,State,ZIP) �� i udi g ot <br /> Irot_a n(City,State,Zip) It la a PHONE I PHONE *` ';E-MAILADDRESS backE-MAILADDRESS <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) � i eta approval from <br /> PARENT PAR EL UMBER: ZONING:(http://accessdane.co.daAnceR.EAWGLEU:S/) <br /> 1"::}12 x/ 2cabjetoLPShl e <br /> ❑ NUMBER O j63,� / J� �7 �, �j � ` <br /> TOWNSHIP: SECTION: • n ' �° " <br /> i,p-: 5 W 1/41/4: J �, -le`•W `ss g tat g <br /> tV it e4ci fEn r <br /> ADDRESS: E <br /> .04plan5 o sc ,. <br /> CSM: LOT SUBDIVISION BLOCK/LOT r { „ <br /> ITIL--.-LIN444=1-114ii"Ottygmjfaq <br /> PROPOSED PROJECT INFORMATION c_jvc,k,ss d .fade r wn to scab <br /> PROJECT DESCRIPTION: ! I ek$ r `f�z. <br /> E P lye a permits,g.af <br /> ❑This project is a new building or structure. l e� t r;town : <br /> This project is an addition/alteration to an existing building or structure. <br /> r1 t�'p rrnrts <br /> SANITARY SERVICE: PERMIT NUMBER: ' t <br /> ❑SEWER ` SEPTIC 3 <br /> HEIGHT IN FEET )/ t NUMBER OF SJORIES: (Not including basement) <br /> ll�.11 etlafid7flt�od04111: <br /> h©re1and (attachment) <br /> AREA TO NEAREST SQUARE FOOT: Ai` ( u <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> EroSaat, ntrotiperral <br /> BASEMENT: 1ST I OOR O ' <br /> l/I��JJII TOTAL SQUARE FOOTAGE: 4, tots tsLu�an,C '- <br /> ItlingfacceSS) <br /> 2ND FLOOR: 3RD FLOOR: l O p� i _ i <br /> U <br /> ESTIMATED CONSTRUCTION COST: ODO 00 and `iogat[ot�of . <br /> ♦ -► '+ -r -► --► and'aValla l o ttotts Y ', <br /> (Please round to nearest dollar) 7` Q� _ - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes fNo ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes �I No ❑Don't know <br /> 3. Have you talked with the township about your project? Yes ❑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 a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ❑No ❑Don't know <br /> 7. Is this correcting a violation? V ❑Yes C1 No <br /> 4 ra8 ` AT <br /> (Continue PPLICATION on BackMUS) BE-+SIGNED-i♦ <br /> 545-112(troe) <br />