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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 /> -fk\0MRS k 1 tC t-IEL,i v U RAP0? Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 180,0 .lOtatJ`yo1J 1 STbv 61-TO,J W2 5"3581 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> bWI-8ll sca7 N .(MX Ca 2.31c1 eSf3C•1Ob4 •ne't ErSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CHRtS NEUIMIo.4-2 SViRlx; &ALOt & ce OE.S16/J " JC- Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3185 pc-C.tz PoIrIT DRIVE <br /> (City,State.Zip) (City,State,Zip) Setbacks <br /> s'1.0v64i,k 1o0 WL 53589 <br /> PHONE PHONE II Site Plan approval from <br /> 60$ -S77- 113 I applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS a <br /> CA/IS e Sf.cxwbu,?clefs•corm 0<loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Ievation of property <br /> LIPARCEL a r- fron ge drawn to scale. <br /> NUMBER Q 6�o511'Zi3-Q3�`-Q R� "a c.09 <br /> TOWNSHIP: SECTION: <br /> 000 ktAK x711 1/4. St.V '/a'/a. S�1 nvew Its <br /> ADDRESS: — (state, OUnty, own) <br /> CSM: LOT SUBDIVISION BLOCK/LOT anitary pa.o its <br /> 06'377 cA (public, ,nvate <br /> PROPOSED PROJECT INFORMATION 1 4tevI , <br /> PROJECT DESCRIPTION: tip <br /> NEW SINGLE via M,U- �om6 e'er' t %�-r l <br /> . SIThis project is a new building or structure. ti - <br /> sIor � <br /> ❑This project is an addition/alteration to an existing building or structure. m s,4 � V <br /> SANITARY SERVICE: PERMIT NUMBER: ,� ; 4 y - <br /> EWER SEPTIC 13 -o�O1 rJ-oo oti35 - . � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 6 A <br /> a . 1 ,0,,F <br /> AREA TO NEAREST SQUARE FOOT: � t ^- <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: wA ,j tea, z , �� 3$ <br /> 16 1 a 6 4% 4, TOTAL SQUARE FOOTAGE: - <br /> 2ND FLOOR: 3RD FLOOR: y <br /> II-I <br /> ESTIMATED CONSTRUCTION COST: $35.01000 _:,# , ,!i, <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? ZYes ao DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes ao QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes DINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes tao <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# t ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ao ['Don't know <br /> 7. Is this to correct a violation? QYes lalo <br /> S APPLICATION MUST BE SIGNED <br /> 1 (Continue on Back) -e. <br /> 545-112(4/08) <br />