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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT;T to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE 2 <br /> OWNER NAME _ <br /> EVTtiINE fE�F fT012A6E (JAMIE LINDAU) filZoningStatus;CUP;C q o (/U <br /> OWNER ADDRESS (Number,Street,City,State,Zip) a eed Restriction;CSM <br /> 311 CNE" ENNE lRAl1., MA 'iSON, WI 5•hi05 Variance(# ) p <br /> HOME PHONE (CELL PHONE E-MAIL ADDRESS ``O P <br /> jliha�AU G11AGhtPi.GOm ��% - : , drawn to sca - <br /> AGENT INFORMATION I CONTRACTOR INFORMATION . . . . S <br /> AGENT NAME CONTRACTOR NAME <br /> 1?212I D&ET G iz 0W N 4iy IRI A N SIGNS, NO. ,(4 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Of` IC <br /> 3001 1'E'J'I STREET 3001 17ekkl STIzl ei L /a /0 <br /> (City,State,Zip) (City.State,Zip) Setbacks <br /> MADISON WI Si 313 MADISON WI S 113 <br /> PHONE PHONE /a Site Plan approval from /VA_ <br /> (PR• 111•-M-11 (904,•1.11,101101 appli p. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> brid•,th-roWnt 6wjoinriol-n.r.nli- to►iolbcteroyotb3ryunrio�nr.nti-. -:( Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: q CURRENT ZONING: ACREAGE: <br /> [PARCEL 031101061— 54'$�I0— I C—1 { ntage drawn to scale. <br /> NUMBER / r /1 /i <br /> TOWNSHIP: SECztpN ' S y/ ' 1 a/ W y p <br /> T•0WN OF MADISON f A: Imo- /4A: �1/ Drivewa erm�it <br /> ADDRESS: <br /> (state,county, <br /> rLOWfJg <br /> +01 W. Kla1 iE N l9FIWA' , MADISON, WI 53.113 I�Sa ' -.ry permits <br /> / <br /> CSM: LOT SUBDIVISION BLOCK/LOT : bll ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PSIGMA&ECRIPTIOyO/5x 3 Z//x/ i4/,,,,t /0,,5 3L t ) 4 Zoning District Cr-� Q <br /> . ❑This project is a new building or structure. A 'f� ©o-t" Permitted Use? h L 1 <br /> ®This project is an addition/alteration to an existing buildin s uAture // 1 <br /> �0 / / XiI if ig Rural ,• = ', h <br /> SANITARY SERVIC PERMIT NUMBER: / t <br /> EWER PTIC 5 5 3 /110,44- (new/ ) <br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> / , / � ' Shorelarid .(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionCtxttrol permit <br /> BASEMENT: .....________& 1BiT)R <br /> 'Z .2_tf + TOTAL SQUARE <br /> FOO TAGE:TAGE: + d <br /> bance, <br /> fitlrg/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> J 7_,.. ... .Z o) G <br /> ) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST and available options. <br /> -I. -0. -I. -0. -1. W I" p D. <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 al. [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes Lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QX Yes OW <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) [Yes Oto ['Don't know <br /> 7. Is this to correct a violation? [Yes ao <br /> 0_/0/1 If , A /16,. . + e) N, APPLICATION MUST BE SIGNED <br /> p� 300, 00 C �� (Continue on Back) -+ ♦ -+ <br /> 545.712(4108) �"`LC <br /> • <br />