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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /RvC/< STvp LLC ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5-6 8 rob)66-6) Rd. 4Ly2/0A) w/ S3 S3 y variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS/� <br /> 603.-girl/- R K i 26 Z—�3�—0158 190 tr✓cI s'ti) e -"4,7 - 6a1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C fki s CfZ0'Ui'J (or .l^/8 Sr ,tif J71/,3 .5/64. /4C . ❑ Site Plan including location <br /> AGENT ADDRESS J CONTRACTOR ADDRESS DR r J° of well/septic <br /> 122( 1/647-ot pQ/06 122 1 ..✓6,'7 .'2& & <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> J�^/�f 'u-t- , wt C.?r'/6 j y-,4/6✓/Lt*, vat .12 f 4/6 <br /> PHONE PHONE ❑ Site Plan approval from <br /> bag— 7S1- (, 3 3 k0?— -$ `/ - (, 11 applicable township. <br /> E-MAIL ADDRESS , ADDRESS <br /> Ccroa-1 in e n 5 St' . ,S_ Cam SG„l.1 e : ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL MBER OS/Z— 241—`?57-0 - / - Z frontage drawn to scale. <br /> NU <br /> TOWNSHIP: SECTION: <br /> 41.—e/04 2_3- 1/<: lJ 6 '/e'/4: S6 ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 5.'6 8 114-06E*r gel • ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION ¢¢`` j 7 gy.' <br /> PROJECT DESCRIPTION: <br /> 31'.5 "X .2. ' X 100 ' py/a'► S�q�: 1?-- ®® ° ' � <br /> J e - <br /> r]This project is a new building or structure. -.?_;-,-, - ii1 � <br /> Z This project is an addition/alteration to an existing building or structure. °- <br /> SANITARY SERVICE: PERMIT NUMBER: Mi 4�- t <br /> IXSEWER SEPTIC I '''il0 _ <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) r <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) . ,, <br /> BASEMENT: - 1ST FLOOR: TOTAL SQUARE FOOTAGE: 1 r' t li -e l'R qA° ATE. , �'r <br /> 2ND FLOOR: 3RD FLOOR: u �� � � -q Sr 191H <br /> ESTIMATED CONSTRUCTION COST: $ -�n /)( (> heat` fq 1[ a !m a <br /> (Please round to nearest dollar) "� "� "� ! l V ._, <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? Z Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes ❑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) Z Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Z No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ♦ —► <br /> 545-112(4/08) <br />