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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION �f /� Cu'TOMER TO PROVIDE <br /> OWNER N Jl)ttt £ o/�1. ' `' <br /> OWNER AD/R)ES (Number,Street,City,State,Zip) Zoning Status;CUP; <br /> ��� ,1 / D Restriction; CSM <br /> d �e-/A)/� /�Cr' /V(, lf�G?° �'J; �c� 7 i V riance(# ) <br /> HOME'H CELL PHONE "I -MAIL ADDRESS <br /> 2 o i, ,///. it A > ) / 'te Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> e Plan including location <br /> AGENT ADDRESS CONTRACI8�.- � f well/septic <br /> (City,State,Zip) (City,State,Zip) MAY 2 6 2015 Setbacks <br /> PHONE PHONE ❑ ite Plan proval from <br /> plic le township. <br /> BDEVMOMENT <br /> E-MAIL ADDRESS E-MAI UMYPLANNiNG <br /> [Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: fl(f CUR TZOrING: ACREAGE: p p y <br /> ❑ NUMBER 0(.G6?---311--O T 70�O I d , d 3 frontage drawn to scale. <br /> TOWNSH dale-- N: , f /� <br /> pr t� d i f 1/4: N 1/41/4: (V 1= ❑ Drivewa rmits <br /> ADORES :Q `� (stat county,town) <br /> �" t J /S i2 0 ❑ Sanita permits <br /> CSM: LOT ^ SUBDIVISION BLOCK/LOT <br /> ��� (—�J (:u c, private) <br /> PROPOSED PROJECT INFORMATION <br /> ,_ i(°PROJECT DES -IPTION: II y �de r_1‹. 4(--//�, 4 ' f -<%:;;{- <br /> ' ' LI ! 6 /ec der_ 1• $ �DIs.#iict k �'''':1/ <br /> ❑This project is a new building or structure. 4 <br /> �Itted Use? <br /> ;This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: RUI•all ,i° ` ,' <br /> (SEWER (SEPTIC �, € <br /> HEIGHT IN FEET: , ' NUMBER OF STORIES: (Not i c luding basement) <br /> 6 41 . Iv 0 no\ <br /> I �' a€ i , ...ik II'd ,, <br /> AREA TO NEAREST SQUARE FOOT: i {eftdCrrierit) <br /> (Outside dimensions including unfinished area,attached garages and above rade decks r porches) <br /> BASEMENT: 1ST FLOOR: E� %'# € f <br /> TOTAL SQUARE FOOTAGE: + `"s i • i z <br /> 2ND FLOOR: 3RD FLOOR: 3 ` ��i �'i;Lit'ROvi� LJ <br /> ESTIMATED CONSTRUCTION COST: Q� / l m( * ',-s) We�onss.° <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �pP 9 6(/ <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? El Yes El No <br /> 5. Is this project associated with a rezone/CUP/variance(pe ' ion/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) 1. ...7 < 6.0 11 yes No ❑Don't know <br /> 7. Is this to correct a violation? !! ❑Yes No <br /> =451. C)(f)4 t A61/)// Z;z-)i)}--12 liXiA-- - LiX' <br /> APPLICATION MUST BE SIGNED <br /> Or/ 1 Jl L,G, LPL ` , , �� / (Continue on Back)etru 545-112(4/08) 17 5/ l 071//1- 6,a! /(/1, c5" ��`✓ ��m <br />