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4. <br /> C.e1 . 3 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-APP # <br /> PROPERTY OWNER INFORMATION <br /> ow�N e.NAME CUSTOMER TO PROVIDE <br /> 1 Ve ( �".r LS Zonin Stat <br /> OWNE DRESS (Number,Street.City.State,Zip) Q ys CUP; <br /> a 3 9 6ec c er 2d f`�end Scat, I. 5 3-� r 9 Deed nes#'action;CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Varian 1# <br /> ) <br /> &p8-51 . %1 o , -f rrutr-ks e f6.6 i -a4 - ' • ��t El Site Plan d wn ca le <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and include mensions <br /> AGENT NAME <br /> CONTRACTOR NAME <br /> AGENT ADDRESS S K , < I dens ❑Site Plan i du ing location <br /> CONT TOR ADDRESS of well/sepi <br /> pity,state.Zip) 1, �� )}I�CC-{ <br /> (City,State,Zip) CC -- ❑S tekS <br /> PHONE ��GLI rl{ ��� C ' k. 5 358 VVV \ ti <br /> PHONEE,, 0,35" - -7g35- ❑Site PI. a • n om <br /> E-MAIL ADDRESS <br /> (mob% applic.'.l_ • n ip. <br /> E-MAIL ADDRESS <br /> SCh u I÷7.-Q� 4-1, 0- t-6,-,1 Q Floor plan to e <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: EI$V OnOperty <br /> PARCEL p <br /> NUMBER 060-7 ('�� — p fp�� :cc �,t� fronta drawn to scale. <br /> TOWNSHIP SECTION: <br /> Ser,�. c& r 1� '/<: 1J �i 1/1/. NE Drive permits '• <br /> ADDRESS: • town <br /> No.1\0ci- Asst ma e+ br Gakk� �d . <br /> CSM: L T SUBDIVISION <br /> BLOCK/LOT Sanitary permits <br /> ��4 5 (public, <br /> PROPOSED PROJECT INFORMATION <br /> .1 <br /> z <br /> PROJECT DESCRIPTION: € z <br /> ��S dent e - � � �I't 4t -�Lft�M t n C ,d, ' 4r-C` <br /> This project is a new building or structure. <br /> k � � <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: _ <br /> EWER ( EPTIC 3- �C�l S— c o ` � <br /> HEIGHT IN FEET: > <br /> b i I t NUMBER OF STORIES: (Not including basement) <br /> 1 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' <br /> BASEMENT 1ST FLOOR: <br /> ' �` L� 6'Q l� 4, TOTAL SQUARE FOOTAGE: 4, ;,..,.,::::_:,.,7., ,,,, / <br /> 2ND FLOOR: 73RD FLOOR: r� <br /> NCR NIPr _ <br /> ESTIMATED CONSTRUCTION COST: '! <br /> (Please round to nearest dollar) i ♦ .4. .4 -► -► Q�1 604 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYesVo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes goo <br /> DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? fYes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes •1°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) Dyes Jo QDon't know <br /> 7. Is this to correct a violation? <br /> QYes RIo <br /> 545-112(4/05) C c/0 /l/ 0 67 V APPLICIT IG <br /> " (Continue AT on ON BackMUS) BE S NED <br /> 'i 6j?ri, > (2- , <br /> OP/A6t i fl''°11 16 ZitiaL(At ett-t v'_e', # <br /> 1 <br />