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1 <br /> 1 <br /> e •ZONIN ERMIT APPLICATION .countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 7742-AA/e4/ <br /> �L III Zoning Status; CUP; <br /> OWNERADDR (Number,Street,Ci ,State,Zip) /// Deed Restriction;CSM <br /> �� '�� � � u' Variance(# ) <br /> HOME PHONE I CELL PHONE hi s E-MAIL AD.RESS <br /> iv- - /* -1,-, 61//7";41121-4,, Ccf7/4 ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> A ENT NAM I a v i OR NAME, - C=%?e/�4 ' <br /> /P- -'/ _, ,e, x ❑Site Plan including location <br /> AGENT ADDR <br /> irI44/.-46/2%fi= <br /> CONT'' OR ADDRESS of well/septic <br /> (Ci State,Zip) (City,State Zip) ` ❑Setbacks <br /> 14 ' l7/t-/`-I, GO 'c— - <br /> PHONE PHONE ❑Site Plan approval from <br /> 9,Q ;IrP -,<5:Z ■ -- -rr applicable township. <br /> E-MAIL ADDRE• E-MAIL AD.RESS <br /> 7?-1 .v FeligL./A-041ST S dio - , ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: <br /> PARCEL -y e� �j' O frontage drawn to scale. <br /> NUMBER 0 / /' - /�4� / ✓ . f. ..° <br /> TO N IQP: —o SECTION: � / <br /> f r 1/ + A/___. - J� 1/a: 5v 1/1/:i\�/ ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: / <br /> • °Z-Z 7 1 � ■ `�- ) t 2/ ❑Sanitary permits <br /> CSM: LOT SUBDIVISIIN BLOCK/LOT <br /> D r / (public,private) <br /> PROPOSED PROJECT INFORMATION ' > F . EVIEW <br /> P��RyyOJ;ECTDES•r'TIO / / kE <br /> . <br /> This pr. - is a new b (ding or structure. E ; ,® �l .y p e <br /> ❑This pr. it is an addition/alteration to an existing building or structure. - 4;'A- `5 <br /> SANITARY SER : PERMIT N MBER: <br /> • WER EPTIC f t .• s `�; <br /> HEIGHT IN FEE NUMBER.F STORIES: (Not including basement) �� � ,, x�- ff <br /> AREA TO NEAREST SOUA'E FOOT: .< 1 <br /> x; � ,, ,ate <br /> (Outside dim: -ions including unfinished area,attached garages and above grade decks or porches) x . t1 <br /> • •Ste• �1• r t <br /> / ,T: '7� /' j TOTAL SQUARE FOOTAGE: ,j 4 ` • �> ��_� • RC6, � <br /> 2ND FLOOR:OOR: 0 3RD FLOOR: pf °9 : �: <br /> - .. ^0 =/1-11.2715 ci 50f "3 X.'7S> 7'7,'710 ,� ••-Y <br /> '50 : <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ ?! ,t: •1,- 7� ; <br /> (Please roun, t. nearest dollar) �V (2/2�,�� , ,:, 4, = , <br /> t ( • cV <br /> 1. The prop: is within 300 feet of a stream or 1000 eet from a pond or lake? ❑Yes 10 ❑Don't know <br /> 2. Is there a :tland or floodplain on or near the prop:rty? ❑Yes �o ['Don't know <br /> 3. Have you a ked with the township about your proje t and are they in agreement'? ElYes o <br /> 4. Has there b:en a zoning permit issued for this prop-rty in the past 5 years? Ores Do <br /> 5. Is this pro e•t associated with a rezone/CUP/varian e(petition/appeal# ) (leave blank if none) <br /> 6. Is a locati)n survey required? (see reverse) ❑Yes 0 o ['Don't know <br /> 7. Is this to sir ect a violation? [Yes /1 o <br /> -///\ APPLICATION MUST BE SIGNED <br /> 54sttz a/oa °�- (Continue on Back) -. -► <br /> t I \ <br /> I <br />