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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME (�.,, fi <br /> G thV L II M St� 1)04Y/toe v 10 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State Zip) Deed Restriction;CSM <br /> �jt12 4Z Jt u St�x ` v� `� W S I Variance(# ) <br /> HOME° ONE vS 'CELL PI-jN / E- AIL ADDRESS <br /> (�l 8'31 r5(TI- N A- N A- [4 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and indudes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> DaS SSG CA.&-tOVVI,110VYtCS EX Site Plan including location <br /> AGENT ADDRESS C NTRACTOR RESS of well/septic <br /> 4-01 N,C{,AtWAJ Aveinu,c <br /> (City,State,Zip) (ci`A,Mate,Zip) 52 jp Setbacks <br /> PHONE PRONE "J (xi Site Plan approval from <br /> C UQ b C g�-y�) �- 4-4- D applicable township. <br /> E-MAILADDRESS E-MAIL ADDR S <br /> i 1 I Cant fueutmitt.com xi Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE T ZONING: ACREAGE: 3 x Elevation of property <br /> [PARCEL (14-10610-67.2.-1123-0 A ON( S1 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> gUY V 0 14: 1\16 1414: NW p Driveway permits <br /> ADDR ss: Q (state,county,town) <br /> CSM: LO 4 �TJ �� / • <br /> s �� BLOCIULOT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT SCRIPTION: <br /> S N IA:AMC C61Is tin <br /> VrtM• Zoning tlistr64t <br /> • his project Is a new building or structure. f , WHO <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> EWER ji0EPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 0 c <br /> /-�� s eaa r <br /> 4 9 I <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) j E , — ,-, <br /> BASEMENT: 1ST FLOOR: <br /> Zl q ` .®✓ --3(0,4b j TOTAL SQUARE FOOTAGE: 4, ., ,° <br /> ° <br /> 2ND FLOOR: <br /> 3RD FLOOR: 541.C1 58.4'U <br /> � <br /> ESTIMATED CONSTRUCTION COST: �(Please round to nearest dollar) ♦ --o• -11. -0. -ii. ♦ Q / C ( AZ. ' <br /> ° <br /> 3 la LH -1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Olo [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Olo [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? K]Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Wlo <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 ENo 1$;)on't know <br /> 7. Is this to correct a violation? [lies [ to <br /> `� APPLICATION MUST BE SIGNED <br /> (A.C66 (Continua on Back) -► --► <br /> 545-112(4/08) <br />