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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 /> re.Wim SCSP r r g/at. C1'�r D "' "C- Zo ing Status;CUP; <br /> OWNER <br /> illrgit ADDRESS (Number,Street,City,State,Zip) D d Restriction; CSM <br /> 2-y57 CQe^Scene -Ort. Mc.fArch.vo1 1.*4 -s CSS'S'8' riance(# ) <br /> HOME PHONE CELL PHONE E-AAILADDRESS <br /> -02.—$ . " ' ,/r Si Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> f H` DAVIS f26.17-+e r& ' letJ ❑ Site PI cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of Il/s ptic <br /> 31132 6244-T ytti6MwAy N <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> Coj'(-hais 6-Ro t""c S3r22 <br /> PHONE PHONE a Plan approval from <br /> g q'37- cI/00 . applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> J c z ,-,f3,ica7Avks, CO 14,Q1ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevati of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER oZ-8104[0-o'/ -2r.ry-(• E'^ I fro ge rawn to scale. <br /> TOWNSHIP: SECTION: <br /> ' o"-' of NA/t-/ 1/4. <br /> %.1/4: <br /> ❑ Drive permits <br /> ADDRESS: ( ate, nty,town) <br /> 2-8S( CREStc^.1 a- Mc. FAA.-ettN0, w <br /> CSM: LOT SUBVISION BLOCK/LOT El San' - <br /> [)I :-rmits <br /> (p c, .rivate) <br /> PROPOSED PROJECT INFORMATION REVIEW l <br /> PROJECT DESCRIPTION: ' 'V ;: ' <br /> D e—c. 1,✓I Vdtri chc- P o w e l i t c 11 L/ F 1-- n . <br /> . , This project is a new building or structure. r e , <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> y <br /> SANITARY SERVICE: PERMIT N MB ., <br /> SEWER SEPTIC r ew ► 3 ° . <br /> '� r. <br /> HEIGHT IN FEET: NUMBER F ST it including basement) <br /> Ea :9 t <br /> AREA TO NEAREST SQUARE FOOT: �� s�tfdCrrteTtt <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1r. i .4''' ' <br /> Q 7 )- l TOTAL SQUARE FOOTAGE: j „ €+ r � !, t <br /> 2ND FLOOR: 3RD FLOOR: <br /> ,. <br /> ! ' .w: 1 tr; <br /> ESTIMATE CONSTRUCTION COST: available O Ih <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 El Don't k o <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes ❑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 ❑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 />