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9--CS101 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ` <br /> .---P-'te S� Se J ❑Zoning Status. UP; <br /> OWNER ADD S Number,,Street,City,state,Zip) Deed R tr' ion; CSM <br /> 2 l( ? /zt YIV�- ( 1 Or¢�.clf 6r �3 7` 'F'' Variance ) <br /> HOME PHONE CELL PHONE E-Mp}ADDRESS �/ <br /> 332- X035- l4 La_ ® -( l• etc+ 0 Site Plan d`aar�to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includsiimensions <br /> AGENT NAME C�, TRACTOR E (�� 1r/// <br /> J�:n d OoJ 1 fr sd ralto, ❑ Site P+ i t • ,0 ocation <br /> AGENT ADDRESS CONTRACTbRADDRESS �,/ / of we i --It; <br /> 2Y2— JJJJ4 <br /> (City,State,Zip) (City,State,Zip) El Set►-• s <br /> LZtel w I 51s-617 <br /> PHONE PHONE ❑Site NoAt • =I from <br /> ( D & -S /6 —V 22 1 appl •w- hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ` <br /> 6 IR• 0 0 1- ela,V, ❑Floor plan 6-scale <br /> PROPERTY/LOCATION INFORMATION (htti,://accessclane.co.dane.wi.us/) Elevate n property <br /> PARENT PARCEL NUMBER: /� CURRENT I G: ACREAGE: <br /> 0 NUMBER Cq© ` 3 / D ��, 3( frontag raven to scale. <br /> TOWNSHIP: SECTION: <br /> 1 till, TV. '/4: '/4'/: ❑Drive y <br /> ADDR ss: n f} /� J (stat , c u y, wn) <br /> �(-C1 i "" cift Co ❑Sanit- : it <br /> CSM: LOT n <br /> SUBDIVISION BLOCK/LOT <br /> (pu• • 'r�� -) <br /> PROPOSED PROJECT INFORMATION ST REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zorn District <br /> Vi This project is a new building or structure. ❑ PermittiGse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SE VICE: PERMIT NUMBER: ❑nddress <br /> EWER �EPTIC isting) <br /> HEIGHT IN F T. \,....7 l NUMBER OF STORIES: (Not including basement) <br /> ❑ Sho'' • -; ••• ain/ <br /> AREA TO NEAREST SQUARE FOOT: Shot- (atachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) y <br /> ❑ Ero }•zt4 of permit <br /> BASEMENT: 1 n I 1 1ST FLOOR: ,� /j� <br /> (/11 l/ 1I 4 TOTAL SQUARE FOOTAGE: j (S{•I' = e • •_nce, <br /> P filling/a cess) <br /> 2ND FLOOR: 3RD FLOOR: ' <br /> a� �� ❑ Re • -w /.yam. . _-- ey <br /> ESTIMATED CONSTRUCTION COST: $ ^ ` rj and - -' - sle • s. <br /> (Please round to nearest dollar) ♦ ♦ ♦ --► v/.4e. <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes LINo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Elo QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Res EINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es to <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) IYes ENo QDon't know <br /> 7. Is this to correct a violation? Eyes INNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -. <br /> 545-112(4/08) <br />