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ZONING PERMIT APPLICATION www.countyofdane.coln SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> vVYZ vA of u---)e■ <br /> OWNER ADDRESS (Number,Street,City, te,Zip) �`e� Zoning Status; CUP; k-- I <br /> hJ ( 4�,� S �' 4y�CU�1l l S� Deed Restriction; CSM 30 <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# IQt <br /> AGENT INFORMATION CONTRACTOR INFORMATION 0 Site Plan drawn to scale <br /> AGENT NAME and includes dimensio s <br /> CONTi CTOR NAME <br /> AGENT ADDRESS •• a 7 V e. • eluding location <br /> CONTRACTOR ADDRE of II/sept <br /> (City,State,Zip) `� ` `•1``21e.1/4r C a . • <br /> (City State,Zip) Setbacks <br /> 1ig 4 <br /> PHONE AL DSO•^ kU �� c7Z f! 0 PHONE` c_/ Site Plan approval from <br /> E-MAIL ADDRESS` O?^�� —� L � applicable township. / ��- <br /> E-MAIL ADDRESS <br /> L , c „ra Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> 0 PARENT PARCEL NUMBER: ( CURRENTZONIN ACREAGE: Elevation of property if <br /> NUMBER <br /> ER OJ/ 2 — /pJ ,1 1 C '�_•• __ frontage drawn to scale. <br /> TOWNSHIPPG� ` �`�� fronta e <br /> A F© SECT y;— <br /> ADDRESS:,© � (j 5 1/ 1/a1/4: gi Driveway permi <br /> CSM: LOT SUBDIVISION BLOCK/LOT „Sanitary permits <br /> � !IA _ ----� (public,private) <br /> PROPOSED PROJECT INFORIVATIOU <br /> PROJECT DESCRIPTI N: STAFF REVI <br /> Sx l. �,e -0G rh`� IAA f_ Zoning District <br /> • This project is a new building or structure. g 3 <br /> This project is an addition/alteration to an existing building or structure. M Permitted Use? F <br /> SANITARY SERVICE: PERMIT MBER: <br /> 2 0 J S Address <br /> H GHT IN FEET: <br /> NUMBER 0 a 3 (Re existing) <br /> F NUM MBER OF STORIES: (Not including basement) f <br /> 4 ►e.� o Ana �eqk Imo- Wetland/F000dplain/ 1i /∎ <br /> Z AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dim sions including unfinished area,attached garages and above grade decks or porches) <br /> rri- <br /> BASEMENT: 1ST FLOOR: Er SIOnCOntrol permit ti I-/ 61 I a`4 L - t// / , TOTAL SQUARE FOOTAGE: + (slopes,disturbance, /j ) / <br /> 2 FLO R: 3RD FLOOR: filling/access) /' }�r ' <br /> ESTIMATED CONSTRUCTION COST: `A���L �� .1 Review Location Survey <br /> (Please round to nearest dollar) '� -� ♦ -► and available options. D i <br /> . � Off•= p �4 ti <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> 3. Have you talked with the township about your project and are they in agreement? 'J'es oo Don't know <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ElYes JIo <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) <br /> ]Yes DVo ❑Don't know <br /> 7. Is this to correct a violation? <br /> QYes 'VjrVo <br /> APPLICATION MUST BE SIGNED <br /> s45-11z was) (Continue on Back) ■ -0 --to <br />