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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER�1lo1 L-Y� \) i1 ns� El Zoning Status; CUP; <br /> OWNERADDR S (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> s) O .. S Cr'c CQ�n W rN R 1 � � ��J Variance(# ) <br /> E PHONE CELL PHONE E-MA LADD _ ( __.[ r <br /> k Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION _nd includes dimensions <br /> AGENT NAME q CONTRACTOR NAME <br /> t-j S 0111\ El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR AD ESS gcz of well/septic <br /> W f 3"b[.p k <br /> (City,State,Zip) (City,State,Zip) —, ❑Setbacks <br /> Ii1 7e) S '535 toc- <br /> PHONE PHONE _,� El Site Plan approval from <br /> 0 c e 0$ ,3/�` applicable township. <br /> E-MAIL ADDRESS E-1�qAILADDqRESS <br /> CJ ,�I )ci 1.-G ad yr , ,C-- ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZO ACREAGE: <br /> 0 Ei <br /> PARCEL O S/cy_ (fir_/�1 _ _3 <br /> NUMBER 1 )_ / 0 , kr-7, frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> • l'(--31 t'l_, et 1/4: 1/41/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 7o3 c 62 c, <br /> CSM: LQT�.,(c �,n SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> c� ! (public,private) <br /> PROPOSED PROJECT INFORMATIONvST OCI6kU1- RiLk PROJECT DESCRIPTION: ^� t " ,.;.:.:A <br /> ent^ UL�{ 0 �'Arlln; 8 r = § <br /> .�'f <br /> . ❑This project is a new building or structure. d' f <br /> ❑ Perm �e?,.� <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 RuralAddress <br /> EWER [EPTIC (new/exing) r" <br /> HEIGHT IN FEET U NUMBER O1TORIES- (Not including basement) <br /> J V a$. t ) #h <br /> AREA TO NEAREST SQUARE FOOT: <br /> ', <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,0 n =r ' <br /> BASEMENT: 1ST FLOOR: tt <br /> a <br /> ,, TOTAL SQUARE FOOTAGE: 4, (slope ' - i s GS,'` <br /> 2ND FLOOR: 3RD FLOOR: lung! <br /> �� S7 <br /> ❑ Review . : yey <br /> ESTIMATED CONSTRUCTION COST: • — c.� a D-b and 440*,,, e�ins . <br /> (Please round to nearest dollar) i , <br /> '''1-):::i 0 z t" <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? . Yes QNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves Vo ['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 o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#1°C ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes k/No ['Don't know <br /> 7. Is this to correct a violation? ['Yes %I o <br /> (P APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i -♦ <br /> 545-112(4ro8) <br />