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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 /> J,tn�SS �L4Si t Zoning Status;CUP; <br /> MTADDRESS (Number,Street,City,State,zip) Deed Restriction; CSM <br /> �(1 C o / 03 J , 31-tLaC 44 , /A 535) S' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> og G 7 353 Gd8 la Z OA Z ':14"_ t ? Q,U e f C 0 5-1-s•cov''t- Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -)ekt eliL IZEt,Li1Z - 14,Ii:LL' Z t i S ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> W 1 2Sd3 w4itT'v&Z. 20 <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> (moo 01 , wT- S 35SS <br /> PHONE PHONE ❑Site approval from <br /> GOb V43 148 I a ca le township. <br /> E-MAILADDRESS E-MAIL ADDRESS 1 <br /> esov ke,l(er-® hvgl es ,(tQ ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) 1=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER bloc 0-3 195o3-0 IN- 1 1 06g3 35- 5 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> UGitnIoNi 3 ' : N6 '/41/4: St; 11 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1.1. 6 5 GooAei 20 .y n _ <br /> CSM: LOT SUBDIVISION BLOCK/LOT -�+'(pu(publbl ;. ItSO <br /> i private-N /( <br /> PROPOSED PROJECT INFORMATION , F - V <br /> PROJECT DESCRIPTION: <br /> I� <br /> Nt►`J 140)06, , 7 <br /> . IThis project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. :, a <br /> SANITARY SERVICE: PERMIT NUMBER: .i. °. - <br /> __FIEWER �O EPTIC )3 QO/ S^c I ct rw t F <br /> H IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: ., <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: '77::,t," <br /> ' • � ' <br /> r b ZS .2-17_4— 4, TOTAL SQUARE FOOTAGE: + (s o• <br /> , <br /> (N)I e , <br /> 2ND FLOOR: 3RD FLOOR: A a <br /> 3/ S7 \ pan' {„° <br /> ESTIMATED CONSTRUCTION COST: $ . . .. : <br /> (Please round to nearest dollar) '♦ '♦ ♦ '♦ -► ♦ 31-2100 Oo o k e ' <br /> I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres E No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Des fNo ❑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? EYes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# l O GP,3) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes I No ❑Don't know <br /> 7. Is this to correct a violation? Yes [RVo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />