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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 /> f g„#1 °` nets ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,Cly,State ip) <br /> ti �1 /� e,V i-� ) 1 Deed Variance Restriction, CSM <br /> A L t7o e � O, ►t'>s �•f�,S9� Variance(# ) <br /> HOME P ONE CELL PHONE E-MAIL ADDRESS <br /> '"gP2) ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT ME <br /> CONTRACTOR NAME <br /> Woe, t�/� C �.r,�.1111 . fdrp• ❑ Site Plan including location <br /> AGENT ADDRESS /� CONTRACNR ADDRESS p of well/septic <br /> c „ / 6a)»9�'v J ue• /9© 1;2017 tS+� Pa4P.6? ab <br /> (City�,p�te,Zip) (City, tate,Zip) ❑ Setbacks <br /> Mc, ,1L 6/D l9 ye »a L,2i ,�3.5 2.i <br /> PHONE PHONE <br /> Site Plan approval from <br /> 6..C5e—77)'o34.5 4,6X—211 -5-- 271)0 applicable township. <br /> E-M LADDRESSo / E-M• LADDR SS <br /> Wt a rc .: A,:of,, .aa�N LG4/ ' -/ , 4.,,,44-,,,,..., El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CUR NT ZONING: ACREAGE: <br /> ❑ PARCEL �1 a 8 7 frontage drawn to scale. <br /> NUMBER Wyl?1a VS/401-247��� <br /> TOWNSHIP: SECTION: <br /> �/4: 1/a%4: ❑ Driveway permits <br /> ��``°`? �j r`�'` (state,county,town) <br /> ADDRESS: <br /> �bj <br /> `�f ���� °1 / • L3 X3.59'9 El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ST movie Y <br /> PROJECT DESCRIPTION: s� / gnu -* , <br /> d s/7r Vb)r// 6 OL1 'I ing Us€ i ,4,,, - <br /> . This project is a new building or structure. ® P . Use? <br /> ID This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> U , .+ <br /> SEWER SEPTIC t '€ ° s <br /> HEIGHT IN FEET: NUMBER OFSTORIES: (Not including basement) <br /> l� 1111 iganC� I ' <br /> AREA TO NEAREST SQUARE FOOT: ' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOO �h�+ + �� <br /> .�— �/ 4, TOTAL SQUARE FOOTAGE: 1 �� , • +(� nce, <br /> ' �� �, <br /> 2ND FLOOR: 3RD FLOOR: <br /> 9h0 " % <br /> Li Review LocatOia SitiveY <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ ..+ ♦ ♦ ♦ .40p- r?lS. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y s I rJ o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [ Yes ❑ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ['No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i one) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓ No <br /> dI <) APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 - –■ <br /> 545-112(4/08) <br />