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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME n _ 1 <br /> 4/4n'10et /t-/' u IN Zoning Status; CUP; • L <br /> OWNER ADDRESS (Number,Street,City,State Zip) Deed Restriction; CSM :10 5/.`/b 4( Lonolan Adi ./ ei �'•e4q car ,5.xs31 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> tg Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 4/j <br /> AGE NAME CONTP^ TOR NAME n� !! <br /> Dry 2c it / C�&o7 �...1.4;45.0. a Site Plan including locatio , <br /> AGENT ADDRESS CON CTO2ADDRESSS of well/septic <br /> c2,Q40l 64)»04•00 ii T c 160). 7r w7.42, <br /> (City 63/301;9 State,Zip) (City,State,Zip) � Setbacks 0 Dos,i., rt. t9".v»vj L: l ,5'x'9.5. . <br /> PHONE PHO II_� Site Plan approval from ro <br /> 4 as_?,d_ O f ZpZe-sc1(�^2 zoo .pplicable <br /> , <br /> township.N <br /> E-M ADDRESS E-MA ADDRESS / � <br /> ze.e/mac/e. b...Id , , Of rt ./ h .l <br /> $k..J4 sJ z•�I II Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:S 1°I Elevation of property <br /> El NMBER B 7/,/- 4. M-a 14'd- v I V / <br /> frontage drawn to scale. <br /> TOWNSHIP: //�/ SECTIO - <br /> ��,,,� r/Lic�- i�� 1�4. w 1�41�: N F iin Driveway permit <br /> ADDRESS: Yom_ /n� � A. (state,county <br /> Tb`'r Ltijon Ai pet A.Al i.o= 31s,1 IV/ Sanitary p- '•'ts <br /> CSM: i , Z 0 LOT 3 SUBDIVISION BLOCK/LOT (public a <br /> PROPOSED PROJECT INFORMATION - " <br /> PROJECT DESCRIPTION: • / if' , <br /> sol,yy,.1/ G.- a"je-/.1 lic".1e. OA • ing Dist t 1 <br /> This project is a new building or structure. (/17/ ,e 30 15 ,F erthitted U <br /> ❑This project is an addition/alteration to an existing building or structure. - <br /> SANITAgY SERVICE: PERMIT NUMBER: I - `` ' <br /> �/9 SEWER SEPTIC e, ' <br /> 3 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ` ' <br /> /5•a11 / 0"WetlandiFbodpiaint <br /> Shomiand (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) : 5' � rol p <br /> BASEMENT: A 1ST FLOOR: } � � ) <br /> A/4 /d.20 4, TOTAL SQUARE FOOTAGE: 4, :is.v.> d ,,..;,,,,,t-,:„ d <br /> 2ND FLOOR: 3RD FLOOR: s / <br /> /gap <br /> ESTIMATED CONSTRUCTION COST: and at j ble p <br /> ♦ ♦ ♦ ♦ ♦ ♦ $ � <br /> (Please round to nearest dollar) evq.5;Qroa <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes E]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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ ■ <br /> 545-112(4/08) <br />