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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME/i_ c ` <br /> U e- O r 1 {�(�'r'���G C�C�" oning Status; CUP; <br /> OWNER ADDRESS (Nu r,Street ity.State.Zip) <br /> ^n \ Deed Restriction; CSM <br /> �(o`t CO ......_. I " `c�� �U De-Cove S"f L11. .533 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,r. -7/Z-'Z3$ -Fi-re.:1r ' 2- @ .0/'94,/ L'o^, ePlan drawn toscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME 1 CONTRACTOR NAME <br /> U-, ec....r1 Ite ncludinglocation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of we'') \' is <br /> (City;State,Zip) (City.State.Zip) etbacks <br /> llrt9N0,- U I <br /> PHONE PHONE ❑Site ' a• -pproval from <br /> a•• . -. etownship. <br /> E-MAILADD- E-MAIL ADDRESS <br /> loo--plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> eation of property <br /> Y PARENT 008 ARCELNUMBER: CURRENT NI ACREAGE: Q I:1 NUMBER /01 I U 1/ Z -1 O A _! Cr <br /> frontage drawn to scale. <br /> TOWNSHIP 1 , SECTION: '��.Z' C_` <br /> W\�6So r ii'9_/O '/4: ruG An, .1/4,4:�0'",vX;/y ❑Driv- a <br /> - •er town) <br /> ADDRESS. <br /> 7(o`1 1p Mo-e i2. - <br /> CSM: Via SUBDIVISION BLOCK/LOT <br /> ❑Sani • its O <br /> (p , •rivate) C„ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEC ESCRIPTION: 'l <br /> /�\j ttl� Bo ;\a*,n 3o� x Si t Ltit . pning District <br /> . ®This project is a new building or structure. <br /> CP'ermitted Use? <br /> This project is an addition/alteration to an existing buildin or structure. . <br /> SANITARY SERVICE: No.'s.JL S,r veL) PERMIT R: of ddress <br /> EWER REPTICi,tC\AC (news <br /> HEIGHT IN FEET NUMBER OF S OR S: (Not including basement) j jam]14 etjc'Z IiFi(•.•air 0 <br /> ' �� Sh. _ - 'R attaChme <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FL00 t'oStonCont •j permit <br /> 1 Q j TOTAL SQUARE FOOTAGE: I (S.Opes,---U bance, No <br /> f ljin cress) <br /> 2ND FLOOR: 3RD FLOOR: /..1 I �c v ;61-c k- Review Location Survey <br /> ESTIMATED CONSTRUCTION ♦ ♦COST: $ 17 00 0 and available optlflns\ <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ lJ <br /> / H ih <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gNo ❑Don't know �J <br /> 2. Is there a wetland or floodplain on or near the property? Elites 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? :Yes 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) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -4 <br /> 545-112(4108) <br />