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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to 1911013-App t< <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN A ER NAME gra ge /T_" r/ <br /> Zoning Status;CUP;zip) ��T <br /> OWNER ADORESS (Number.Snot.City.sow. Deed Restriction;CSM /, T <br /> 3,7 Y 6,11m/if••. Varianoe(# ) <br /> HOME PHONE CELL PHONE --IE•IAAILADDRESS <br /> 6 Of (Y6 'Iry 601332-Z 3 t13 06./,i e -41 /. "61'1 /"• Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 44 <br /> AGENT CONTRACTOR NAME 4 <br /> SELF S E'c_F t Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wellseptic 00/'(City.swo.Zip) (C" .Stele,,Zip) 4Setbacks 6 /o <br /> PHONE PHONE Site Plan approval from j <br /> applicable township. /4... <br /> 'E-MAIL ADDRESS E-MAIL ADORESS <br /> OFloor plans to scale <br /> PROPERTY LOCATION INFORMATION (http: accessdane.co.dane.wi.us ) Elevation of property /0 PARENT T R: C •T 0 : ACREAGE: <br /> PARCEL on. o9/I-Oat-1002-O Al 19. 8y0 frontage drawn to scale <br /> TOIMISHIP: SECTION: <br /> g/fit)( 4-4-Il 'h: Area Y4%:, S 0 Driveway perm A <br /> / state,county,s2 <br /> ADDRESS: 3 /7d7 6,'/ 9'79 .• i2 of <br /> A Sanitary •,., <br /> CSM: 35-06 LOT SUBDIVISION— BLOCK/LOT (public �' <br /> PROPOSED PROJECT INFORMATION / I " <br /> PROJECT DESCRIPTION: �r,u44 iy/ows C- 4 j y (3 SIX/ /o Zoning District 4 r <br /> This project is a new building or structure. .fitPermitted Use? /d S ,❑This project is an addiboNalteration to an existing building or structure. G r r1, <br /> L- <br /> SANITARY SERVICE PERMIT NUMBER: A!, ,-- <br /> o sawn }01 SEPTIC [ural <br /> - f HEIGHT Nr FEET f / 1 NUMBER OF STORIES: (Not including bosomsnt) <br /> b f _∎. ...plain/ <br /> horo - attachment)AREA TO NEAREST SQUARE FOOT: <br /> (Ott dimensions including to finished area,attached garages and above grade dodos or porches) rosionControl permit BASEMENE ISTFLOOR: / + TOTAL SQUARE FOOTAGE: j SIOpES.dlsturUaflCC, �'"lling/access) •'2ND FLOOR 3RD FLOOR: /b y�` b V eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -• ♦ ♦ ♦ ♦ $ �O 0 nd available options. <br /> (Please round le nearest dollar) <br /> .. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes J'No ❑Don't know <br /> 2 Is Mere a wetland or floodplain on or near the property?.Aa t•...444 etPr. Oyes $No ❑Don't know <br /> 3. Have you liked with the township about your project and are they in agreement? j2 Yes ❑No <br /> 4. Hes theme been a zoning permit issued for this property in the past 5 years? U Yes gNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal ft ) (leave blank if none) <br /> e. Is a kr(adon Survey required? (see reverse) ❑Yes ,No U Don't know <br /> 7. le MIS to O i eOt a violation? 0 Yes ,No <br /> , APPLICATION MUST BE SIGNED <br /> (Continuo on Back) • -► -► <br />