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66o- (-o <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> il.A 3 seivx 3 J(.d kph <br /> OWNER ADDRESS (Number,Street,City,$fate,Zip)n 'Y -` ❑Zoning Status;CUP; <br /> 5(o 73 0 oS�- 0115 RAI, (Akt+G/400, WT S•3SQK Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> AGENT ❑Site Plan drawn to scale <br /> GENT INFORMATION <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 3t,►e� °el In 6rea* 5"4"0i.j,-CejrgA b�I p J Site Plan including location <br /> AGENT ADDRESS V CONTRACTOR ADDRESS ■! <br /> N? 7 W Fed pvl-ov L. of well/septic <br /> (City,State,Zip) y <br /> (City,State,Zip) 1 )( }1tr 0 Setbacks <br /> .k .k t4tea" Lai. S`l l 3 0 n <br /> PHONE <br /> PHONE ❑Site Plan approval from <br /> Lgd �7 u a� ` 3 1 " r,J ig g CP applicable township. <br /> E-MAILADDRESS / E-MAIL ADDRESS <br /> • - --A � tIl•Gd►h - Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> NUMBER 03G/Oe i -13 3 4� l R 4 _ 3. 0 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Ai C ih,0\ 13 1/a: AlE 1/1/a: 5t,,,/ ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> SG 73 O 0$C.k 1'5 <br /> CSM: SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> o aq 3 s i (public,private) <br /> • : . • . - . • : . . • ■ It L • <br /> Y <br /> PROJECT DESCRIPTION: F d 4 a ' <br /> 1a ' x l a ' 5Kel,rd.ID fIA Addy--n,v <br /> • DThis project is a new building or structure. <br /> his project is an addition/alteration to an existing building or structure. '�� � `� ;° <br /> SANITARY SERVICE: PERMIT NUMBER: 0 MOIL, e-€ , `€' <br /> EWER FIEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �„ q <br /> 1 3M <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: • a� . € • 7 € <br /> /411-i j TOTAL SQUARE FOOTAGE: 4 r }$:' ft <br /> 2ND FLOOR: <br /> 3RD FLOOR: --� �€ w ,��,_. <br /> ESTIMATED CONSTRUCTION COST: QQ � R ' A <br /> (Please round to nearest dollar) ♦ '. ♦ ♦ ♦ —► $ iJ 3 7 `, •$a 1� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ® lo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes \lo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? OYes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes Elio <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none) <br /> 6. Is a location survey required? (see reverse) QYes blan <br /> QDon't know <br /> 7. Is this to correct a violation? QYes Jlo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />