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'73 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / , '/ �j �j <br /> /0 .,- ' /19 e vo/i�fr n ❑Zoning Stat�7s UP; l <br /> OWNER ADDRESS (Number,Stree qty,State,Zed Deed Restriction; CSM <br /> `a v 1 nei Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> .'s- 3365- ❑Site Planldrayrrto scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incluaerg dimensions <br /> AGENT NAME CONTIWTOR NAME <br /> I)eIllA,5 �Q - 4JK ❑Site Pla in ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s ic <br /> (City,State,Zip) (City,State,Zip) / ❑Setb <br /> / // <br /> PHONE PHONE cI IA) r 57,-9? ❑Site P n • •ro -I from <br /> 60 - )2(22,0 - 7937 appli /'. 'nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> U'r/c44 in,ciLibm a 7�5,rte,t ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER o9vg -.3qa bad-3` frontage dra00�t/o�._`q <br /> TOWNSHIP: n SECTI•k• (/ �,() ,'�n <br /> DANE 3 7 '/4: 4 4'/4: /U� ❑ Driveway permits (Je V L <br /> ADDRESS: ,7 2t7 a (state,county,town) <br /> (// Ot <br /> CSM: ��p LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits f <br /> D ! / (public,private) , �I r vv\ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: r �' <br /> 0 Zoning rs�trict° <br /> . Errhis project is a new building or structure. <br /> 0 PermUse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 R ral Address ' <br /> FIEWER 1'EPTIC i,3—c7)0/57-00/-7(/ /existing) <br /> HEIGHT IN FEET: 0.9 / NUMBER OF STORIES: (Not including basement) <br /> / 0 Wetla •/,o <br /> Shor 1: •. a ' chment} <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> 0 ErosionCo <br /> BASEMENT: t'�( 1ST FLOOR: �,�!(� <br /> ���1 `_ ,I, TOTAL SQUARE FOOTAGE: 4, (slopes,di e , <br /> filling/ac <br /> 2ND FLOOR: 3RD FLOOR: 1-- <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ wo CEO, `w © Revle i : • rVey, <br /> (Please round to nearest dollar) $ 30 f O and a .. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves jNo ['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'? 5s ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [ lo <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) Er.es ❑No ❑Don't know <br /> 7. Is this to correct a violation? Eves Flo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -► -► <br /> 545-112(4/08) <br />