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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C 4 OMER TO PROVIDE <br /> OWNER NAME nn � �/ <br /> (S I -r r. ii-T z 1,-IC II Zoni Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) De d Restriction; CSM <br /> /0 i I -( //LL LO M r(fv1--0 �� <3 v lance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> , o r- 13 -o Lib 60Z— 25 C-9/"73 6g.c7 mac: ifL z K /I Zf00-co ❑ e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION n 'ncludes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) Se acks <br /> PHONE PHONE ❑ to Ian oval from <br /> pp ca a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Fl or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of pr y <br /> PARENT PARCEL MBER: CURR T O ING: ACREAGE: <br /> PARCEL frontage n to scale. <br /> ❑ NUMBER Oft oco6-- 3- o/f �- 7 <br /> TOWNSHI SECTIO •�J ,/a: S % 4. ❑ Dr' way permits <br /> �" ( ate,count •wn) <br /> ADDRESS: <br /> /0 --t I L � /1-7q_ 'vJ ❑ Sani -• permits <br /> CSM: O '�e;1 LOT 1 SUBDIVISION BLOCK/LOT p 0 c,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> /�)0Pr- Z <br /> o�v OPr ‘( OP I yl I <br /> 0 =rig <br /> . ❑This project is a new building or structure. J i);•,,, 3,• <br /> ,.a <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 R @ .(r@ ' <br /> f SEWER SEPTIC 0( (newl Y ' 3 ra <br /> . , <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> / / O W i °,.# e e e tatnl <br /> S e 'a a ,.(atta , -no , <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Li <br /> e:..,on; c e�°fit <br /> BASEMENT: 1ST FLOOR: <br /> Z PO f—f Z •,, TOTAL SQUARE FOOTAGE: (`±s° ,di ,,', e, <br /> 2ND FLOOR: 3RD FLOOR: �2 <br /> 2 F/ .won SurekJ <br /> ESTIMATED CONSTRUCTION COST: e ,a norms <br /> (Please round to nearest dollar) ,V, ,;y,,,,,., <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 St•lo ❑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 /> 6. Is a location survey required? (see reverse) ❑Yes Fg.No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes gi,No <br /> r-- APPLICATION MUST BE SIGNED <br /> 545-112(4108) <br /> 7 l .. (Continue on Back) ♦ ♦ ■ <br />