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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME } n <br /> M 5 Kh� -°- GL� ❑ Zoning Status;CUP; <br /> lowiECRe.ADqP 9kES9-CNumber,Street,City,State,Zip) <br /> �S I S 5un'►m )}- ►2i°dge Qet Mitt� 0I. 5-3 S't1Z Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE LL PHONE E-MAIL ADDRESS <br /> s4, ZD(e—# O2 Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Pat/e aas5m u$Sen Cornet-1- \iome. Lr 3 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 0o Boy 494!a M- /fin tWT P•o & t w tnevitSd'1 k71 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> rr &C SOY1 t li 5'3' I'- Maxi,'+ sail ; WI , C3-7. 17 ❑ Site Plan approval from <br /> PHpN�4l` 521 _ ) //sq PHO( b%` '.33 - Z$.�.7 applicable township. <br /> E-MAIL ADDRESS T[� `T E-MAIL ADDRESS <br /> u,-ca Corrl•e , , •rh // ♦ el • , , ,(o/VI ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONIN ACREAGE: <br /> e �� Q�l C3g G6,l o frontage drawn to scale. <br /> ❑ NUMBER 6$0$�3Iz.z1b?`O <br /> TOWNSHIP: SECTION: <br /> SQr1Y15.-� ( 1/4: N 1/1/4: ❑ Driveway permits <br /> /ADDRESS. ,1 (state,county,town) <br /> Sp('j n el OSSOrr) C.0 t,&t 2 Sanitary permits <br /> CSM: OT SUBDIVISION BLOCK/LOT <br /> -i-3-- 14U.}urnn Vona (public,private) <br /> PROPOSED PROJECT INFORMATION STA P REVI)l J <br /> PROJECT DESCRIPTION: ' <br /> Ne.w Constr .t. U ni . III �.t • <br /> • �This project is a new building or structure. <br /> P j 9 ��" �1r'Tt'1!lltl�llrse � <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> it <br /> SANITARY SERVICE: PERMIT NUMBER: CI Rurallddress <br /> SEWER RILEPTIC 13"--. Ze 15. b DD 9 9 0 new existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 25• ,S /A. 2 ] i�d�od sta <br /> AREA TO NEAREST SQUARE FOOT: , a c - <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> � ,,.. : control or1rnit <br /> BASEMENT: 1ST FLOOR: s #aci;essy"t O(� 30 0 W/` 4, TOTAL SQUARE FOOTAGE: 4 , <br /> 2ND FLOOR: 3RD FLt�)R: (s <br /> 2.12/4`7 5 l38. P $°•6'1j I Revert k9Pati Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ 5.O 000 and�a � <br /> (Please round to nearest dollar) ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ©Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes L�J No ❑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 ©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 u No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes ©No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />