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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O NAME /fir <br /> 1g\cka fO -eaJ�e onin Status;CUP; <br /> OWN ADORE Num'-r,Street,City,State p) i - g <br /> le '� 12 toth, - " 01` 153'I Deed <br /> arncee(#Restriction;CSM <br /> HOME PH E CE PHON E-MAIL ADDRESS ( ) <br /> .0 s 'ir.+ ' �J ♦ti !� ` �t ) 1)11.- <br /> I./A� I cite Plan drawn to scale <br /> AGENT INFORMATION CONTRAC*UR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w ptic <br /> (City,State,2i p) (City,State,Zip) tbacks <br /> PHONE PHONE El oval from <br /> R applica Slte wosvhal <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SIO/S oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENTZONIN : ACREAGE: ration of property <br /> ❑NUMBER + I 1-101-14001-o tom/jd �i ' �' frontage drawn to scale. <br /> /OWNS/,� SECTION: • <br /> UI <br /> W .. Uc e, '/a: '/a'/a: ❑Driv- ,a •-rmits <br /> ADDRE .4 ri 8)46 Jr(1 Gad L <br /> (sta ..Unty,town) <br /> .elik.‘f___, v•1 i <br /> CSM: //��++ LOT SUBDIVISION BLOCK/LOT <br /> ❑Sa `: permits <br /> • .• ic, r rivate) <br /> PROPOSED PROJECT REVIEW <br /> PROJECT DESCRIPTION: ,r% <br /> 4 hi, 1 4 Q kS ._ /._I Mr* 0 ■ J 1 I/di Ike G. ing District <br /> qs 1 <br /> • ❑This project Itia new buil.4 g or structure. Use? <br /> KThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U.Rardr ddress <br /> EWER EPTIC ( ' 07 , <br /> HEIGHT IN FEET $1 NUMBER OF STORIES: (Not including basement) <br /> 1 'I I, :: rA,17 ...;. airy <br /> •,i . . . Y-Chm-, ) '' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> = <br /> BASEMENT: 1ST FLOOR: E • '` �j)1. permn/1 <br /> 4, TOTAL SQUARE FOOTAGE: 4, ( 1;rte SturbanCe,/1/ <br /> 2ND FLOOR: 3RD FLOOR: r ill r';�. r r ) IIY// <br /> P VIA • Review •r;, . Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ --► I 't f Q, O O and ., Op ' <br /> (Please round to nearest dollar) "� (o(f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es on't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y s to ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? LJTeS U • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 7 o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i one) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [� to <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -1. -P- -■ <br />