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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 /> AN AI ULSoN <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS Number,Street,City,State,Zip) Deed Restriction; CSM <br /> / 1D thi wk Tat- Tie Fo rest, WI 5353 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6 Ce -WO-a125, DPN 8 P tsco tic," 't ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (tPV1 TA°1soij ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 13 (I, v1 14,,,(,)vv. 5fi <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Defrt5k( WI 5353 <br /> PHONE �J/t� PHONE El Site Plan approval from <br /> ,b8 6� <br /> — —•5023 applicable township. <br /> AILADDRESS <br /> E-MAIL ADDRESS <br /> E- <br /> �� @ P4„ �.�llc* t' ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZON ACREAGE: <br /> ❑ PARCEL 6gt0- O8l -8930-Li f}—�� frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: cy SECTION: <br /> �/�[ <br /> t AA��r 1/4 %IA ❑ (state,county,town) <br /> ADDRESS: 1-0 y0 UAL, K ip iV <br /> CSM: 7018 LOT a SUBDIVISION BLOCK/LOT 1=1 SUBDIVISION permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION %:7 STAFF REVIEW <br /> PROJECT DESCRIPTION: 1 i�� <br /> a� ` q porch �t� sitt , <br /> . ❑This project is a new building or structure. El P ,' i use? <br /> IN This project is an addition/alteration to an existing building or structure. 7 <br /> SANITARY SERVICE: PERMIT NUMBER: yRU Address "''A" <br /> nSEWER •SEPTIC /In 9 sting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) t <br /> 1 0 Wet a w <br /> AREA TO NEAREST SQUARE FOOT: S•,. hai�R , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) © Stion� pmt <br /> rte" <br /> BASEMENT: 1ST FLOOR: y disturbance:,rip I S.F j TOTAL SQUARE FOOTAGE: . <br /> 2ND FLOOR: 3RD FLOOR: <br /> J <br /> ',,Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ aD 000 and ;i:::,,,,,,:,,1 r7 <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ •p i ... <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? El Yes M No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? NI Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes (l 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 0 No ❑Don't know <br /> 7. Is this to correct a violation?f±±... ❑Yes a No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -♦ <br /> 545-112(4/O8) <br /> 11 Y110954- .-*P4 pi-219 ,t b8-53 <br />