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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU OMERTO PROVIDE <br /> OWNER NAME 1 <br /> 1�e_ ( a n '• UT e S .-LC_ Zonis• Status;CUP; <br /> OWN • ••,• SS(Number, City,-, .1. ) f L 53q1.9 0-- • Restriction;CSM <br /> 0 <br /> _ . .a <br /> LA)I r , 11- ILA .dance(# ) <br /> O �-. e CELL PHONE E-MAIL ADDRESS <br /> /0 e*AI/ te0 0 Si Plan drawn to scale <br /> AGENT INFORMATION �CONTRACTOR INFORMATION d includes dimensions <br /> AGE CONTRACTOR NAME <br /> INI,C V S Plan including location . <br /> AGENT ADDRESS CONTRACTOR ADDRESS welUseptic <br /> • <br /> (City.state,Zip) (City.Sate.DP) Er Setbacks <br /> PHONE PHONE • ❑ S Plan proval from <br /> township: <br /> E-MAILADDRESS E•MALADDRESS <br /> or plans to scale <br /> PROPERTYLOCATION INFORMATION (http:/Iaccessdane.co.dane.wi.usi) Elevation of property <br /> PARENT PAR BER: CURRENT ACREAGE: <br /> ®7 c�3 y �l©o a I 7 S frontage drawn to scale. <br /> TOWNSHIP: 0\ IAA, 3EQT1QN1 :y�� <br /> _L�) t11___ 1/4s. w : „te,County,town) <br /> ADDRESS: .. ? 6(c) • <br /> /\�,v, " Ve-tZ .t i c 12 Sanitary permits <br /> CSM: LOT SION BLOCKA.OT (public,private) <br /> ±r - •R <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: 5 -_ 4 Y eL0 4- l. <br /> . CitiThis project is a new building or structure. LAI / 1 )1C k 4- C)e c K <br /> v <br /> o This project is an addition/ eration to an existing building or structure. <br /> • -7'i it .1 „':d:' r -k k <br /> SEWER PTIC It-ao ''CO / Millil <br /> HEIGHT IN FEET. 30 NUMBER OF STORIES:1Not Including basement) <br /> • <br /> AREA TO NEAREST SQUARE FOOT: Q'\ ��� <br /> (Outs'.-TI imens , unfinished area,attached garages and above grade decks or porches) <br /> BAS ENT 77 1STFL•• <br /> • " TOTAL a. p..= <br /> / <br /> 2ND FL i•'11111111.11175111 3RD FLOOR: N M j <br /> le <br /> (Please ESTI _■ 0 CON 11 ' CTION COST: @@ 00 / <br /> (Please rou • o nearest dollar) '• -• -• -• -.• -• $ <br /> i . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes (] o .0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes l0 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ('Yes 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes (WIlo <br /> 5. Is this project associated with a rezone/CUPNariance(petition/appeal# ) (leave blank If none) <br /> 6. Is a location survey required? (see reverse) "Yes 0 No 0 Don't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPUCATION MUST BE SIGNED <br /> (Continue on Back) -► • -► <br /> 545412 i+roal g rt <br />