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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> J OWNERADDRESS (Numbe,Street,City,Sta Zip) t Ing Status;CUP; <br /> 194 S f4 / 04,0, 1Z I ovh 7 O/`G wri_ Deed Restriction; CSM <br /> HOME PHONE CELL PHONE / E-MAIL ADDRESS� �l ����� Variance(# ) <br /> 3-/S , ' ur, ' 4, 4G+OO . Si Ian drawn to scale <br /> AGENT INFORMATION j CONTRACTOR INFORMATION <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAME <br /> AG NT ADDRESS ❑ Site a • cluding location <br /> CONTRACTOR ADDRESS of ptic <br /> ity,State,Zip) (City,State,Zip) S backs <br /> PHONE PHONE- S' an approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> =• plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT❑ PARCEL PARCEL NUMBER: CURB TZON G: ACREAGE: E • n f property <br /> NUMBER � �)9 -&Inl- O ,r / 7 frontage drawn to scale. <br /> TOWNSHIP: II I SEC ION: <br /> 5� �`-�C7J -Q. '/: . 4%: ❑ . ri rmits <br /> ADDRESS - e, ,town unt <br /> t?r3 5f11/?o4irZ Q 0,i7 i& t 14/r 55572_ y ) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sa =- mltS <br /> / (•-• IC, •rivate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: '" � � <br /> fi°ap he vie 3 a )C 2_ a 0. •, 1"inii4/: _ - ' <br /> • ®This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. ' , <br /> SANITARY SERVICE: PERMIT NUMBER \ r r ss ,. <br /> nSEWER �,^�// <br /> HEIGHT IN FEET: <br /> NUMBER OF ST !El; (No including basement) <br /> 1s <br /> AREA TO NEAREST SQUARE FOOT: ' _ ti` <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , � 1lJ <br /> G <br /> BASEMENT: 1ST F OR °��� • <br /> 0 4, TOTAL SQUARE FOOTAGE: `( '6+ , ' ' <br /> iii <br /> 2ND FLOOR: 3RD FLOOR: G 4 `if t° / <br /> : % .� <br /> ESTIMATED CONSTRUCTION COS • ) f" <br /> (/ t . <br /> (Please round to nearest dollar) ♦ ♦ —► -♦ ♦ —► � - sus t s <br /> ffi £ <br /> 'A 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ®Yes ❑No ❑Don't ow <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 ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? El Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# <br /> (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? ❑Yes [iZl No <br /> APPLICATION MUST BE SIGNED <br /> 545-112 iaioa> (Continue on Back) —► <br />