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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> / <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CU OMER TO PROVIDE <br /> Shciclo� K. �ac.�No n h 1- EX <br /> OWNER ADDRESS (Number,Street,City,State,Zip) p + / ©Zoning Status; CUP; <br /> 5a35 Loc.ys-f Gro Roori/Ore o De�dRestriction; CSM <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS n�� V riance(# 3 ti ) <br /> 608 : 5 <br /> • • ► • t • k € A,1_, elf`.1' rig Sit Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d i cjldes dimensions <br /> AGENT NAME CONTRACTOR NAME11 <br /> Sheldon K. To.C�O n o L eUt(dty\ LLC S' Plan including location <br /> AGENT ADDRESS CONTRACTO ADDRESS∎3 well/septic <br /> (City,State,Zip) .. e . ` \ ii • 1 1 • •_• <br /> (City,State,Zip) W/, Setbacks <br /> PHONE ■ I •- to 5350.. <br /> PHONE 0 SI Planapproval from <br /> 608 897 84 act ph 1e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F or plans to scale N N <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> DPARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: vation of property <br /> PARCEL y E ontage drawn to scale. <br /> TOWNSHIP:ER �y�IOSO9�oL3c�.�SS�a`.� R"'� X �Sd? -{- r <br /> SECTION: E s tog Resicte.m- <br /> O r•elo t ..— — —' '/4: NW '/4%: N(ii NJ D veway wrmits <br /> ADDRESS: '�/ / qq ��` tate,county,town) <br /> 5x35 Locus GO Cove. Roos170 -e9ot1 WI BLOCK/LOT <br /> ESani <br /> CSM: LOT $ ry permits �p <br /> (pu Ic,private) <br /> PROPOSED PROJECT INFORMATION EVIE'W <br /> PROJECT DESCRIPTION: .44 <br /> (a �It suitd�� -std srdlt -rn0.dhR w Y ; <br /> • This project is a new building or stru re. Sf'er ¢4 <br /> ' Y '1 <br /> OThis project is an addition/-Iteration to an existing building or structure. - <br /> Iiiiitallir fIIIIIIiaiMFNIIIIIII V*44,41449t:i..,!'M'i,;:14.4 <br /> HEIGHT IN FEET: <br /> NUMBER OF STORIES: (Not including basement) Y a <br /> • • f g k ,x,e, .j!,:,-, ,:i1,-.:Y <br /> l <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` `` <br /> BASEMENT: 1ST FLOOR: ! :• � $ � •��� � <br /> 60 X I ao' 4, TOTAL SQUARE FOOTAGE: 4 .- Y Y - <br /> a <br /> 3RD FLOOR: ' <br /> 2ND FLOOR: <br /> Y P'° j4-o- <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) '' .+ '+ .+ "► ♦ 70 f 0 0 0 °p° r k Y g e L.) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ®No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? %Yes QNo <br /> 4. Has there been a zoning permit issued tpr t is 6r ertftheat 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 "lo ['Don't know <br /> 7. Is this to correct a violation? FEB 1 3 2014 ['Yes , No <br /> DANE COUNN P'LANNINCI&DEVELOPMENT APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ —► —► <br />