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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEit NAME P //'-, <br /> /v/i T� , . )�!3�e L&) S rz31 <br /> Zoning Status; CUP; 5"- <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / <br /> /2 70 /7//L L S//2 /� 0A 0 62�G6", 72 i' , GcJ/. S 3 S3[� Deed Variance Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 25'0 -/299' KE'sJGcJC-S7`72 6'(,/t R/2OAJ A-Jet ,!rd Site Plan drawn to scale es <br /> AGENT INFORMATION CONTRACTOR INFORMATION - and includes dimensions/3 6 o y <br /> ./ <br /> AGENT NAME CONTRACTOR NAME <br /> XI Sit: ...�' ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 0 4 �„, <br /> U tam <br /> (City,State,Zip) (City,State,Zip) 1 13 Setbacks / c / <br /> PHONE PHONE Site Plan approval from <br /> applicable township. N/ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> '. Floor plans to scale ray <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I� Elevation of property <'70 <br /> PARENT �Jp8'�///-i 1 .. URRENTZONING: ACREAGE: , <br /> ❑ NUM ER RI/ '. 3/ frontage drawn to scale. <br /> TOWNSHIP: SECTION: 1I <br /> /9L/3/oA) N (A) .1/4: NC 1/41/4: Swketh l Drivewa permi <br /> ADDRESS: - <br /> /Z 7 0 /7'i Le.--S/P6- ROP1 1.) <br /> CSM: LOT SUBDIVISION BLOCK/LOT p► Sanitary permits ��Y <br /> /3 6 p L/ 1 (public,private) � <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ,,,, <br /> /3EDRc7m A �)n17?aw ' ,A0 ? tnct - <br /> *- X15,y <br /> • ❑This project is a new building or structure. <br /> ;:' tti <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> FISEWER SEPTICZ � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) r <br /> AREA TO NEAREST SQUARE FOOT: J Y t.t �l <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,"4.1 '',- <br /> BASEMENT. 1ST FLOG / $ €$ e 'of � <br /> Fr <br /> X 30 Fr Z 6 x 3 0 Fr- TOTAL SQUARE FOOTAGE: � ( fist ante �`�� <br /> 2ND FLOOR: 3RD FLOOR: �Iln �') „J.- <br /> //t r/ <br /> 6 0 _ „---/- / r <br /> City a iT�� <br /> ESTIMATED CONSTRUCTION COST: �� �� -and ava . $ -, i� AV <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ "♦ ♦ $ / 00, U U o. - - l',`, ','' ':''''-'- /f.._ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ZINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes igiNo ❑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 '4 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 No ❑Don't know <br /> 7. Is this to correct a violation? x <br /> \,— ❑Yes No <br /> / APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -■ <br /> 545-112(4/08) <br />