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9 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> SUPPLE to Web•App# <br /> 1Dr�� <br /> PRO^ERTY OWNER INFORMATION OFFICE USE ONLY: % 1)6 OW NAME <br /> r e 6 C. i ii l39 Zonmg District OWNER ADDRESS (Num er,Street,City St e,Zip) 0 1- <br /> /Q, 26 �. e e V� I,e y .'O GO( Permitted Use�x n P E 52— 3 /q E-MAILADDRESS� � LOrngStatus,�Gl�p, .;', t"� io(.c�AGENT INFORMATION CONTRACTOR INFORMATION Deed<'"'Restriction„CSM�`- <br /> AGENT NAME CONTRACTOR NAME <br /> AGENT ADDRESS CONTRACTOR ADDRESSCS <br /> antl mctudes dimensions ^}��, <br /> (City,State,Zip) (City,State,Zip) / <br /> life Planmclutlng=location* <br /> PHONE PHONE Of"'Well/S�ptIC <br /> E-MAILADDRESS E-MAILADDRESSD <br /> tbacks, S(� <br /> PROPERTY/LOCATION INFORMATION htt //accessdane.co.dane.wi.us/) <br /> ( P� Site Plan approual from <br /> PARCEL / PA• EL�jIJ�(IB�F}:` / D ZONING: A 1 ACREAG �/� 77%% LL LLI/LL �/ � applicable tow�shlp <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> ,C i ✓ 3 Z S �^✓ In,/ Rural Address'= i <br /> 1/a: 1/a 1/a: (new/ xlstln• , <br /> ADDRESS: / ,� �Q <br /> /0 t l� �� /COL ,© Fl or ian <br /> CSM: LOT SUBDIVISION BLOCK/LOT a'� <br /> ®..Efe�ration`of property <br /> PROPOSED PROJECT INFORMATION y o frt gtag-7._'—4vfe scale'. <br /> PROJECT DESCRIPTION: <br /> C <br /> W : �rtvwy_p ' s t 't <br /> ❑This project is a ne - or structure. .- (state,caur tyftoin) <br /> (This project is , additior :Iteration to a existing buildi`: . - �:, <br /> SANITARY SERVICE: PERMIT N BER: <br /> ❑SEWER SEPTIC .SI' I I <br /> HEIGHT IN FEET: NUMBER OF STOR r <br /> c� ��Wetland/Flo�tl�lain/ ��..s <br /> / Shorelanel Gt aears -. <br /> AREA TO NEAREST SQUARE FOOT: (DG <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) J 3 f ro s I on Ce rl trope rm it <br /> BASEMENT �^ 1ST FLOOR: 5105ISttirb�rce; ,,,:4,..::. <br /> / TOTAL SQUARE FOOTAGE �� � , p � <br /> .,::,. . <br /> ///��� flllln / a - <br /> 2ND FLOOR: / r� 3RD FLOOR: ?g) i/S ev,ew Rocalxion Surrey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -► and available o� ons <br /> (Please round to nearest dollar) �� �D`' <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?. � ID yes CI 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 �10 <br /> 5. This project is associated with arezone/CUP/variance(petition/appeal# ) (leave blank if none ivo 6. Is a location survey required? ❑ Yes �n't know <br /> 7. Is this correcting a violation? N� ❑ Yes D•- e'''�■ <br /> $s6 � <br /> 4---71(vt �h APPLICATIO = <br /> � � L` �`�� c (Continue on Back) —► —► -♦ <br /> 545-112(1/08) 1�L��'�� s c <br />