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(S' , 20 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> DWNE$pttaOMFV n A n,l.12 <br /> OWNERRADDRR(�ESS Number,Street,City,State,Zip) ❑Zoning Status; CUP; <br /> S6 0°4 Ln c%,r 4ej � /15-j,& ( C'P 5-3s.L8 Deed es ction; CSM <br /> Varia (# ) <br /> HOME PHONE .... PHONE E-MAIL ADDRESS <br /> (°8---5-77-46:"- 6'O8--s77.l04 1e; 4o% E/ec fir; .1� Teri'el' ❑Site Plan dra o scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and inclu dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> .�� .A1et 4 4./ <br /> z. El Site Plan i uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s tic <br /> S 6 g y !`--Ic4i,.,f a/ Y� de Ai <br /> (City,State,Zip) (City,State,Zip) ❑Setbal <br /> C L-✓74- S-3S.)-v <br /> PHONE PHONE <br /> Site Plan ppr a om <br /> ‘Dq -5'77—6.8-2-.S— appIicabl tc ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /7 p=k 4/L C7C'c J vQ ca j T12(,n e t ❑Floor plans a-scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) V <br /> ❑PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevatl o operty <br /> PARCEL <br /> NUMBER <br /> 9� O 2 E�x 1 • ��7 frontag awn to scale. <br /> TOWNSHIP SECTION: /A, <br /> e/- /...3 /V i,,/ ihy4: ii/ ❑Drive a efts <br /> ADD ESS: ` (state U�1ty,town) <br /> 6'ei gct r4l C�sff/--ii ' C.-'s.)- o ❑Sanita :-,i0.s <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,p i 4 -) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> a giztOe ot1,4 ., LI Zoni Itt <br /> ❑This project is a new bui lding or structure. <br /> 17 Pe l/44 i <br /> is project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural •�• yss <br /> )WER PEPTIC (new/e M'g`f) <br /> HEIGHT IN FEET r 1 NUMBER <br /> i.OF STORIES: (Not induding basement) ❑ Wetland/F�e�I in/ <br /> AREA TO NEAREST SQUARE FOOT: Shorel-nd (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLO ❑ E v.I•' 'o trot permit <br /> f + TOTAL SQUARE FOOTAGE: j (S p;--1 •isturbance, <br /> 2ND FLOOR: 3RD FLOOR: (,, filling/access) <br /> `� ❑ Revi •,;,. : Survey <br /> ESTIMATED CONSTRUCTION COST: and av II 1. •: ions. <br /> (Please round to nearest dollar) '0. '♦ ♦ ♦ ♦ -► $ dd Qe570 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Zro ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeslo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yeslo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ,124 <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (lea. blank if none) <br /> 6. Is a location survey required? (see reverse) ,�21 flo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes j " <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />