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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU •TOMER TO PROVIDE <br /> OWNER NAME <br /> NE <br /> 1 iisfQR -r ?kre_c.o. VA c-M,AKA., Ni Wing Status; CUP; <br /> OWNER ADDREE S (Number,Street,City,State,Zip) <br /> eed Restriction; CSM <br /> 11414 `I gAw∎ oS6 GE,� 1 -t Kr. 1-LTRA*54 ,W'K. 53512 ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Loa■ COO . _ - :• .. .' . .■c ■A w.4 L - dte Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d i cludes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1QQ VID*1 MCMAv.,.,rk lACiAL*np, QNe4S-1-004∎04- 47 Site Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> za5`d rtt.e.v.--. P4 11 <br /> (City,State,Zip) (City,State,Zip) ❑i�9etbacks <br /> igtme Wloutsoa, S35 Vi. <br /> PHONE PHONE 1:1 S'e Plan a_pprbval from <br /> Cato& 235 - 3503 licabltr township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> WlciAn .. w L'w.,.i ' s L <br /> dhoor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: (� CURRE ZON1ING ACR/EEAGE:2 p p y <br /> ❑ NUMBER 0,C)07- 103- /1g 1/ .J1-1' I �� H• 6\ outage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> yNgoyg 10 1/a: SL 1/41/4: S■,J D veway permits <br /> ADDRESS: - tate,county,town) <br /> 044, Fes'"i t.o Ve Ceswxet. ca0. Kr. lAmitigib. tjr. N3,512. San' ary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> z• IV t (puali•,private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 14 } 1.A•vv er _ District <br /> . IX This project is a new building or structure. <br /> Use.. <br /> ❑This project is an addition/alteration to an existing building or structure. :, <br /> SANITARY SERVICE: PERMIT NUMBER: L,R °€'.¢a{, <br /> (SEWER [SEPTIC 13 - 201'5 - 000 i-5 (a 1 e <br /> HEIGHT IN FEET: w NUMBER OF STORIES: (Not including basement) , <br /> 0 of <br /> 2.'3 -.0 t#6 e� <br /> • - _ (a chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 Ewa �; : t <br /> BASEMENT: , ] 1ST FLOOR: q 7 9 , ,,, <br /> /)L.r/ I7 TOTAL SQUARE FOOTAGE: 4, ,, ° € ,,,, <br /> 2ND FLOOR: 3RD FLOOR: <br /> )(C , .,.. . <br /> ESTIMATED CONSTRUCTION COST: , ;, ,$ <br /> and ai � <br /> (Please round to nearest dollar) "♦ "♦ ♦ ♦ 3W 1 Iw 0 ;1 5�� :::4; ° '» <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ENo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 2No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 0 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> V APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► <br />