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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> CS.>k KV 4 CO N la Jo z- "1 1 Ln R 5 517 Planing Status; CUP; <br /> OWNER ADD ESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 3(,( 9 CO0IJ TK RDA 1> JC-7-1 p3LX6MoOM DS, wI Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 665 43/5 5' X 68 Z-n s;1 z3 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 13 0 fl J*N N Site ' - 'I ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of k~epti <br /> 4,o-z,- SON►1 tz D J& <br /> (City,State,Zip) (City,State,Zip) p, Setbacks <br /> /3to ,14.0 t) Al D , 1A1( 535/7 <br /> PHONE PHONE [: Site Plan approval from <br /> 60e ea 3 d— /0 q v applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> b eih o g yy k f G . rids Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑ PARCEL b(,p 6 O 1- Z3 o E 23.2 frontage drawn to scale. <br /> NUMBER —1 i A 1~ x <br /> CWNSHIP: SECTION: <br /> gi,U6,1,tou)Jp� -rOfoN1 04 1/4: i& 1/41/4: stAJ ❑ Driveway perm' <br /> DRESS: (state,county, <br /> 7b VI Go v N -f' (2-t J .LVe- MOO k) DS <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary e <br /> (public, private <br /> 'ROPOSED PROJECT INFORMATION R�� ; <br /> ROJECT DESCRIPTION: <br /> � r <br /> (sct ra.a�� AAA kt-t o f --z, x t s t-,w j-I o os� Dish+ t <br /> F <br /> ❑T is project is a new building or structure. t Use? <br /> IffThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: *M <br /> SEWER SEPTIC a a" <br /> HEIGHT IN FEET: I �l NUMBER OF STORIES: (Not including basement) <br /> 17 - 3 s ,;Vitiation. A# 0 a,nl <br /> shorel n,'� itachnie <br /> AREA TO NEAREST SQUARE FOOT: ,;;/ <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ue Erosion '. trot ,.- <br /> BASEMENT: 1ST FLOOR: <br /> r 70 0 j TOTAL SQUARE FOOTAGE: j + , rbanCe, ,,,`' <br /> 2ND FLOOR: 3RD FLOOR: <br /> �— — �yll do Surie r <br /> ESTIMATED CONSTRUCTION COST: at available <br /> • �,t 7 <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $2�1 dcoo '� '. <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 2 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> cIs a location survey required? (see reverse) ❑Yes giNo ❑Don't know <br /> Is this to correct a violation? ❑Yes igNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />