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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME <br /> 1,-e11/Ur1 H0 PC(0111 ® Z ning Status;CUP; <br /> OWNERADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> 1'1117. L- j-w I4e crr,, P-e5, `7 4w10a, L✓T" 55589 ariance(# ) <br /> HOME PHONE J CELL PHONE :E-MAIL ADDRESS <br /> (Og"i?r73 3610 ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME n1 <br /> I_ C /Q1, <br /> Kill c- 1 e�4c ii to Plan includi g ocat n <br /> AGENT ADDRESS CONRACTOR ADDRESS n 1 of well/septic S V✓� 0.S <br /> (City,State,Zip) (City,State,Zip) La Setbacks <br /> i� <br /> PHONE PHONE ' w� S g ?art El Site Plana approval from <br /> 60e_-gii3 -(IZ7L4 applica)K township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS /" <br /> k2 K6•,.5}or4,5 A 6-rn.LO,,,`I.co" ❑ Ioor to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT 49NING: ACREAGE: <br /> NA Elevation of property <br /> ❑ PARCEL X510 . • 3^&ISO ,�` u 1 �X 3 8 frontage drawn to scale. <br /> NUMBER �O Jf I <br /> TOWNSHIP: N " i SECTION: e <br /> 111\ V I o � V�)c ,�4: .S '�,� ,�4,�4: (►V E. ❑ Driveway rmits <br /> ADDRESS: <br /> // / 1 / I (state ounty,town) <br /> t/ a `. \/1 � - Q ✓ S Q A <br /> ❑ Sanity r mts <br /> CSM: LOT DIVISION BLOCK/LOT (p b' <br /> ,private) <br /> PROPOSED PROJECT INFORMATION MP REVIEW': <br /> PROJECT DESCRIPTION: ON \ C, , s � <br /> This project is a new building or structure. <br /> Pied Use <br /> This project is an additio�alteration to an existing building or structu e. , A <br /> 1� Ut' ,. <br /> SANITARY SERVICE: �r �� PERMIT NUMBER: /� � °` <br /> SEWER SEPTIC t V� / �) (n ° <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not i lading basement) <br /> Sh - $ (a ,-- meat) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) r! <br /> BASEMENT: 1ST FLOOR: <br /> (Z ' )r ZO ' j TOTAL SQUARE FOOTAGE: + �i d',`' of Ce, <br /> 1 4* P-- 1 <br /> 2ND FLOOR: 3RD FLOOR: (91 Io i' , <br /> V.i ESTIMATED CONSTRUCTION COST: anu .=5-s - <br /> (Please round to nearest dollar) —0 -0 —0 -0 -0, —, $ ��� y 4t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Llo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No El Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®'S'es 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 El No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ <br /> 545-112(4/05-) <br />