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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM i <br /> °�4 £ ✓i) 1 ?LA An 3�c-K oning Status;CUP; <br /> WNERADDRESS (Num er,Street,City,State,Zip) Deed Restriction;CSM <br /> av , /✓%�,akso /-}ice J)C5od , s-�L `>37 I ( Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-, 33--07,52 ' - --233- `7a? i rK+•�3GiC'4- 1. Me,e✓ff itePlan drawn toscale <br /> AGENT INFORMATION J CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -7};r- <br /> sue"X _1gw 50°-7 jF%a Ja ',✓f�,..-*/ 0 Site Pla ' cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of se tic <br /> h/8clry /eutsr f) W p, aIi mox.$)� eJ <br /> (Cjp,State,Zip) (City,State,Zip) Setbacks <br /> jot( <br /> /vCrr7 /-1.r 5-3y5-- Pc, , Yrizz t N1E_ <br /> PHONE PHONE ❑Site Pla royal from <br /> /was— 21/5—>pc667 60g - 7-15— - A'S—.16 p appli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS F,,,,�� <br /> 77 a lla<s‘r>a�,S#141.fv oHetSo. 4)Ntx. rcJG� t"tt)-Cc. LV' i N'ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: IOn of property <br /> 0 PARCEL <br /> NUBER (" 12- 3 frontage drawn to scale. <br /> IC - 7 ' .a� g <br /> TOWNSHIP: SECTION: <br /> v)v ) /: '/4'/4: ❑Drive y its ' <br /> V ADDRf�ESS: rty,towP--' .7 <br /> - <br /> a96c k °ryefA Avg- f■14:msorr i.//r- S n s CSM: LOT SUBDIVISION LO OT typrie vate) <br /> / <br /> a Wor,iisst- • 02 6 <br /> PROPOSED PROJECT INFORMATION DEVI 4 <br /> 4/PROJECT DESCRIPTION: <br /> sT r z rrr22— i2.in c n L District OThis project is a new building or structure. E ,_ toed Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li RuF& - <br /> BEWER aEPTIC /f/7t'- (ne' Xis o <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> t,".k ( Li W ,and/F(oodplain/ <br /> r, ;`(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions•• cluding unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> �/� ' i'` <br /> Js Q° � TOTAL SQUARE FOOTAGE: e ::* a a� <br /> 2ND FLOOR: 3RD FLOOR: a ss) j y 4– <br /> LtisRtiM r Location survey <br /> ESTIMA D CONSTRUCTION COST: $ and available cobalt <br /> $ <br /> (Please round to nearest dollar) 130, 000 <br /> .S <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ®Yes QNo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? E Yes Do 0Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ['Yes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ')o <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) es Do Don't know <br /> 7. Is this to correct a violation? es ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) - <br />