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r -_,c, I . <br /> ZONING PERMIT APPLICATION www.coulntyofdane con SUPPLEMENT to Web App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ' r el t n ' 1111/S Lt--C oning Status;CUP; <br /> •,y ADDRESS(Number,street.w . -•) I Q 3 Deed Restriction;CSM <br /> ►�1R 0 l �7 ti u)l� SL• i U c),.1, 1,01.. <br /> Variance(#_________) <br /> HOM PHONE CELL PHONE E-MAILADDRESS / <br /> ti i Al P B Sit Plan drawn to scales <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dlrnens <br /> A 0 TACONTRACTOR NAME <br /> A`7 , 91 �- V _ p;,i .. •0 , location . <br /> AGENT ••-, - CONTRACTOR ADDRESS <br /> (CO.Dab.DO V (clq,slMe,ZIP) • <br /> PHONE P ❑LPlan approval from <br /> • applicable township: <br /> E-MAILADDRESS E-MAILADDRESS <br /> 0 s to scale <br /> PROPERTY/LOCATION INFORMATION (http:'accessdane.co.dane.wi.us/) prop y <br /> PARENT PARCELMJMBErt CURRENTZONING: ACREAGE C�raYVn to Scale. <br /> 13 PARCEL ' _�3 -IS�IO Q*s°1 <br /> TOWNSHIP:t 1 sECnolt <br /> W Y�, ,p clti 9 '/.: S +/.'/: .p , county,town) <br /> ADDRESS: ('� • <br /> q • <br /> 1,\3C1 Co IJ ' / n I ,I W ) 14 permits <br /> CSM LOT + !^ 1 BLOCKJLOT I' 'lie te) <br /> lJ V�•. , <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: `^ <br /> J ► _ L0 <br /> • l! This project is a new building or structure. <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMR <br /> ❑SEPTIC is / Q q <br /> HEIGHT B FEEP. - NUMBER OF (Not IntAM n0 ben) <br /> • <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including Unfinished area,attached garages and above grade decks or porches) <br /> 13J1SE MENT > 10 1 sr Flooit lG 4 TOTAL SQUARE FOOTAGE: <br /> „AA a S! �,Ji , Vv� <br /> 2ND FLOOR: FLOOR <br /> /O ? 4 ,,,,,g )6-1,i- <br /> ESTIMATED CONSTRUCTION`(Please round to nearest dollar) -+-► -r -i -► -► -■ 3 ✓10 0� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes Ili CI Don't know _, 5 <br /> 2. is there a wetland or floodplain on or near the property? ❑yes tr C3 Don't kn <br /> 3. Have you Lanced with the township about your project and are they in agreement? 12Yes ❑lea <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <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 ( 4o <br /> APPLICATION MUST BE SIGNED . <br /> . <br /> (Continue on Back) •• -► -• <br />