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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME // / IA —f.hic r <br /> �4/AD 4-1ND HE/b, / ,//Ek /41N Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> u J 9 " �`r'CA/Y 73 ',c.ii .EIC/oo (if J3599 Variance(# 5 2 <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 607 `/55 y39(O 5AME E/01A 0 c N-4D e F,eoN,</62 ,(-6/71 )► Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimension <br /> AGENT NAME CONTRACTOR NAME CS i <br /> NONE NONE Site Plan including locatio <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Z Setbacks /DO ,S- /0 <br /> PHONE PHONE in Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION FORMATION (ht / ne.CO.d $/) <br /> ANT UM CURRENT ACREAGE: /Oh Elevation of property ' <br /> xiPARCEL frontage drawn to scale. /(P <br /> NUMBER 70/0/La-352.- 4,00-0 Ai — EX 1.05 <br /> TOWNSHIP: SECTION: <br /> Yo R K 09 N 1/4: 0 a E .1/4: 35 ixDrivewa •_rmits <br /> ADDRESS: (stat- coun town) <br /> 659V 1-/AY 73 irc)A ,t'1QO ,:•,tir ,159i X Sanitary p=.••'ts <br /> CSM: 5 / LOT 1 SUBDIVISION BLOCK/LOT <br /> / (public, <br /> • : • • • • • : • . • : II : • . � l 11 <br /> PROJECT DESCRIPTION: <br /> Lis4ED ow SEPE14TE S-14t -1- E ,� �� <br /> . ❑This project is a new building or structure. e / <br /> errlttd Use <br /> This project is an addition/alteration to an existing building or structure. K s; <br /> SANITARY SERVICE: PERMIT NUMBER: Rul-af -,,L: - , � <br /> f SEWER j EPTIC NA (nom • <br /> HEIGHT IN FEET: NUMBER OF STORIE (Not including basement) <br /> APPRoK /0 P t' We ,, .«•.lam ,, <br /> AREA TO NEAREST SQUARE FOOT: %' 1 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: io i 0 <br /> 4, TOTAL SQUARE FOOTAGE: j �Ss �U #$�s I <br /> K <br /> 2ND FLOOR: 3RD FLOOR: �n///�// �� ? / <br /> GJ� vc �„ ` iii /?` m,0. <br /> ESTIMATED CONSTRUCTION COST: an�ila� • ' � iii <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �� ' '. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ( No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes gi No <br /> 4. Has there been a zoning permit issued for thi�pp otp rf years? ❑Yes ®No <br /> 5. Is this project associated with a rezone/CUP/v�rlhi t fr tttit al# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ©No ❑Don't know <br /> 7. Is this to correct a violation? OCT...2..g..2014 ❑Yes No <br /> •.. ?LAMING n ,�r,� APPLICATION MUST BE SIGNED <br /> DANE COUNTY?LANNiNG&Di:'tLo :.iL:•T (Continue on Back) -to -► -♦ <br /> 545-112(4/08) <br />