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T <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU'TOMER TO PROVIDE <br /> OWNER NAVE <br /> 6n S toe V‘. <br /> OWNER ADDRESS (Nu r,Street,City,State,Zip) . ZO ng Status; CUP; <br /> [ + -� " D d Restriction; CSM <br /> 34f(o� } ..�c�e15'crr� S oLi\1 0'`c or 5�S8`� V ri e(# ) <br /> HOME PHONE `f CELL PHONE j E-M ADDRESS -j <br /> Crcq."3 4-gAq't d4 .�3� `�`f S'-ertoack.€ (Awc-LM+4i• (-o:" i Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> it Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑S' a Plan ap val from <br /> icab ownship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> I or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Ievation of property <br /> PARENT PARC LNUMBER: U RENTZONIN ACRE E: P P rty <br /> ❑NUMBER 0 C i C0 �� —c (0 ' " ( frontage drawn to s e. <br /> TOWNSHIP: SE.n <br /> 'v p n 1/4: /\.) F '/4'/4: E ❑Driveway p its <br /> ADDRESS. /(,`, (state,c nty,town) sr <br /> �l `� a` �' �S © " 1 ❑Sanitary permits I /� `� <br /> CSM:. LOT ' SUBDIVISION BLOCK/LOT / J`- <br /> 3 Q�� (pislic,private) !/� <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> a <br /> c f air I- jrasN /� ... g:.4L _ L sn g Pt: <br /> ❑This project is a new building or structure. i ` <br /> This project is an addition/alteration to an existing building or struct re. �; . <br /> SANITARY SERVICE: PERMIT NUMBER: ® kr c a <br /> EWER �EPTIC t& a `0 <br /> HEIGHT IN FEET: ` ,S NUMBER OF STORIES: (Not including basement) (A/ey` yi <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached ages and above grade decks or porches) i,tj BASEMENT: 1ST FLOOR: / Eresl��trryi "1 I <br /> TOTAL A FOOTAGE: 4, .�4� , <br /> j �' �` ftllp'tgl *� , <br /> 2ND FLOOR: I C) 3RD FLOOR: <br /> ESTIMATED ONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 00 r,',� i £r 'e£'fptte t3 .` + vV <br /> (Please round to nearest dollar) �� ©(� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ►'I o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? s o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes rI 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) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? Efres o <br /> a APPLICATION MUST BE SIGNED <br /> ---4C .-9‘ ' *--5 (Continue on Back) ♦ -+ <br /> 545-112(4/08) <br />