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ZONIN e " ERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 0Ah , goacntiarry , /"t ❑ Zoning Status;CUP; <br /> OWNER ADORE• (Number,Stree4,City,State;/Zip) <br /> 9Z)f 6 '/', et- 15nt, Slat�i ► h fi. S35-j' Deed Variance Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> % ?/.5-938 02?9 ❑ Site Plan drawn to scale <br /> AGENT INF'DFtMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> filarD Lc II -. p Site Plan including location <br /> AGENT ADDRES• CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ` p ❑ Setbacks <br /> PHONE S t q Jam, Lit S. SB? <br /> PHONE ❑ Site Plan approval from <br /> (p 0$ Pf3—627 7 applicable township. <br /> E-MAIL ADDRES' E-MAIL ADDRESS <br /> CDUhtr Cow cFia,/lc_ 41167.07,,-, ❑ Floor plans to scale <br /> PROPERTY/ILO CATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL (Z-10/5-4/(70-° [� fronts a drawn to scale. <br /> NUMBER b �H /,(%�G frontage <br /> SECTION: <br /> hc/ /4: ,/4,/4. ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> q. 6//45116/- 14kI�� s1bn1hJ, t 535-s9 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJE T DESC- ' ION �� �REVIEW <br /> �al5� 5 a Zoning D ct <br /> El This proj:ct is a new building or structure. U P. ? <br /> ❑This proj:ct is an addition/alteration to an existing building or structure. �" . :,'t- )4.-fr <br /> SANITARY SERVI E: PERMIT NUMBER: tll'B �TI , <br /> f.E ER TIC r ne f xist 1 ) <br /> HEIGHT IN FEET: x NUMBER OF STORIES: (Not including basement) <br /> ic: AREA TO NEAREST SQUARE FOOT: I� � � � } <br /> (Outside dime .i.ns including unfinished area,attached garages and above grade decks or porches) - . ' <br /> BASEMENT: 1ST FLOOR: ° ` ; <br /> /7 N 4, TOTAL SQUARE FOOTAGE: j ,L • �-, ,,* n ce <br /> 2ND FLOOR: 3RD FLOOR: [ V I gre�� <br /> ij Review Survey <br /> ESTIMATED • STRUCTION)COST: ♦ ♦ ♦ ♦ ♦ ♦ $ �� GIN *And ar <br /> (Please round o earest dollar) / 'C/CJ ` <br /> 1. The prope I, i. within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ❑No ❑Don't know <br /> 2. Is there a w-tl:nd or floodplain on or near the property? ['Yes ❑No ❑Don't know <br /> 3. Have you t-Ik-d with the township about your project and are they in agreement'? Dyes ❑No <br /> 4. Has there b-:-n a zoning permit issued for this property in the past 5 years? Dyes ❑No <br /> 5. Is this proje t :ssociated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a locatio s rvey required? (see reverse) ❑Yes ❑No ['Don't know <br /> 7. Is this to co re t a violation? Dyes ❑NO <br /> V,�` <br /> \ APPLICATION MUST BE SIGNED <br /> 545-112(aios) (Continue on Back) ■ -♦ --0 <br />