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le bit` 60 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION FFICE.USE ONLY <br /> OWNER NAME ft <br /> Zo[�lli t?�sfrlcf <br /> ucivi ' w' 2,4",e,f), <br /> littikiiiiilliMilkataznEntvaiiyp <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / - a"� �., * <br /> 90 3 0ukVIe� c�/'!IfC 5� K <br /> ermlt(4d:zuto- <br /> PHONE E-MAILADDRESS , i, <br /> boo — ?3�63�0 - fsf`/+dv��� <br /> - n :. Status,CUP <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction; CSM <br /> AGENT NAME CONTRACTOR NAME ~ * x <br /> � ���`�rIB�TGe(#t � �� <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> :� t RI4 drawn to scale ? <br /> d ir'ICludes dimensions <br /> (City,State,Zip) (City,State,Zip) m *r X <br /> * ite Plan r cludingiocatior <br /> PHONE PHONE q fi- <br /> E-MAIL ADDRESS <br /> E-MAILADDRESS � � r : <br /> PROPERTY/LOCATION INFORMATION (http a/accessdane.co.dane.wl.us/) "f <br /> t�alproyi from <br /> PARENT PARCEL NUMBER: ZONIN ACREA�GJEQ . ;- <br /> Li PARCEL j D !(J� € .� , cab t4�nS [e? 5 <br /> NUMBER {` � °�'"' ��� '�� � t�R�'�4�'- <br /> TOWNSHIP SECTION: �r ��� . <br /> /� Ir BXIStrf <br /> C' <br /> ADDRESS: f S t r <br /> /'� g <br /> 0J d £p <br /> 8 G (/lGInJ IV/'!✓P ! e <br /> CSM: • LOT <br /> Sup)'VISION BLOCK/LOT �' �� <br /> /6 � /6m� <br /> evat,Q� '31oi { <br /> PROPOSED PROJECT INFORMATION <br /> 4 to eatdr n,);otivg <br /> PROJEC DESCRIPTION: c <br /> --- _--.- E . <br /> ®This project is a new building or structure. /,SpJ sta e � <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> •SANITARY SERVICE: PERMIT NUMBER: .l� 5 �s <br /> ��fi E <br /> SEWER ❑SEPTIC Lz ; <br /> tib <br /> HEIGHT IN F NUMBER OF STORIES: (Not including basement) y - ; <br /> �t1/ :laid idodpialn6 i P <br /> or. larid f attabhmenf)z; <br /> AREA TO N EAREST SQUARE FOOT: t. ' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> i otrote�rmlf <br /> BASEMENT: <br /> 1ST ST FLOOR: 'E r a ; <br /> I TOTAL SQUARE FOOTAGE: S�0PTeS�istUFbaifce <br /> ' <br /> 2ND FLOOR: 3RD FLOOR: Et o <br /> ESTIMATED CONSTRUCTION COST: p <br /> -� -► -► -► -► QQ aid's a�i .9,Pf dtts <br /> (Please round to nearest dollar) �P ( /�d ' pal ",, - - rr <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? <br /> p; e- + No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? -' Yes Flo ❑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? ❑Yes ®-No <br /> APPLICA MU BE ED <br /> 545-112 tt(1/08) (Continue on TION Back)ST =►SIGN♦ .+ <br />