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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> V <br /> �.4� t �1 —}'�1�' -S L L �I' Zoning Status;CUP; A-' - I <br /> OWNER S(Number Sired. - 1-.-• Restrjdbon;CSM <br /> (a DO i • . Wit ,I lj �w k. 5)7/3 Variance(# ) <br /> •ill PHONE CELL PHONE E•MAILADDRESS". I <br /> •– •3(� • ►' Site Plan drawn to scale • <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions �O <br /> SATECONTRACTOR NAME <br /> V e )4 Site including location <br /> AGENTADDRESS CONTRACTOR ADDRESS <br /> P P%smie.aP) (CR.Sere,ZIP) ,Setbacks / d 2 % Cj o <br /> PHONE PHONE • Site Plan approvalfro / k <br /> - applicable t <br /> E-MAILADORESS E-WAILADDRESS , <br /> A Floor plans to scale 1/_/ l <br /> PROPERTY/LOCATION INFORMATION (http:_accessdane.co.dane.wi.us/) <br /> L E@VatiOnOf property�AMER CURREITLONING: ACREAGE: <br /> ❑ D z03_4�l�—Q A _i <br /> /9, F 6 frontage drawn to scale. <br /> I (( �� _ L ADr <br /> `1, L\ S CCTIOPt '�.: '/a'/: S Y Pew <br /> (state,county,town). _ , a <br /> ADO <br /> . ` O©0 l 1,2_, 1 r , . c <br /> !.. <br /> csM LOT SUBDIVISION BLOCWLOT , 1, <br /> 1 , I-oIIIN -- <br /> PROPOSED PROJECT INFORMATION K. . - A - /PROJECT DESCRIPTION: <br /> s re_ -- 1J A r�vE-Lpf\ . S P 4 i <br /> ❑This project is a new budding or structure. <br /> 0 This project is an addition/alteration to an existing building or structure. V1/411° 1 <br /> SANITARY PERMIT NUMBER © J sainc HEIGHT IN FEET`.sraM ° NUMBER OF�` (Not_h b��) r{ <br /> AREA TO NEAREST SQUARE FOOT: <br /> ( <br /> if <br /> Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> i. <br /> B A S E M E N T. 1STFL••-• <br /> �D 9 / / %� 1 G 7 2 ,,TOTAL SQUARE FOOTAGE 3 <br /> 2ND- • FLOOR / / <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ q Q 0 <br /> (Please round to nearest dollar) $ 10 /On <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes OdNo -0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? CI Yes C9'No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Cues 0 N <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Lti No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) � ❑No 0 Don't know <br /> 7. Is this to correct a violation? C3 Yes Flo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/013) (Continue on Back) -I. -. -10. <br />