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ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME/' i r I ..r <br /> i a 1 prN 5 2. t a d s _LcsA.e —L c .�� ,61 . ing Status; CUP; <br /> OWNERADDRESS (Num eet(Ci ,State,Zip) Deed Restriction; CSM <br /> �' T 1 .�1 \ Pcc l�-� Q // rx9J(yv— 1 ���� Variance(# ) <br /> HOME• ONE CELL PHONE E-MAIL ADDRESS I <br /> OA ). 42y+ IN Site Plan drawn to scale / C <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions Alto <br /> AG MT NAME CONTRA TO,RINAME <br /> �cd,Ds ( J-C VJEAl -c�v�Ccw r..59LLO. /PA <br /> • <br /> Site - - '' luding location <br /> AGENT ADDRESS Of CONTRACTOR ADD ESS� ,� n� of ell/sep ', <br /> 77 . s0 6'3/3o/Z o <br /> (City,State,Zip) (C' , tote, ) ii,t sal/6 1/ Setbacks ,�.y� <br /> PHONE PHO E la Site Plan approval from Al <br /> °A (� applicable township. /v <br /> E-MAIL ADDRESS ILAu.RESS � f . J (' ew Floor plans to scale <br /> P [" ems/-� l-�j fQ�')a! <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUR ZO NG� ACREAGE:4TO `, Elevation of property <br /> ❑ NUMBER by 0-ocr3cdasooK ! 1 oC L v frontage drawn to scale. <br /> TOWNSHIP: SECTION; <br /> /'\_ e �� �Q %: ,/4,/4: i1/41 f ,►� Driveway permits <br /> L/E (state,county,4120) <br /> ADDRESS: <br /> w L <br /> CSM: LOT SUBDIVISION BLOCK/LOT a Sanitary - �� is <br /> (public s. - <br /> PROPOSED PROJECT INFORMATION `,STAFF RE'VI[ <br /> � <br /> PROJECT DESCRIPTION: Coo---- 10 tx )3 <br /> � C-G/L �. <br /> This project is a new building or structure. C 7 7-:-;AF .i <br /> t <br /> ❑This project is an addition/alteration to an existing building or structure. .t F <br /> SANITARY SERVICE: PERMIT NUMBER: ,. ' <br /> ■SEWER 4, ,PTIC z=4 l':,-,i& Q , / <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) <br /> : <br /> J— ,D P 4 E aIn/ p /90 <br /> ' a , i <br /> . .e • <br /> AREA TO NEAREST SQUARE FOOT <br /> if t` <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) t ; ® "' °tee . ` <br /> BASEMENT 1ST FLOOR: 1 ^D "- <br /> ✓/ 4, TOTAL SQUARE FOOTAGE: t• _• , .. a- '' <br /> 2ND FLOOR: 3RD FLOOR: 130 1� � / <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ .+ ♦ $ 2 /1 qi� ®� .o se , <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 EfNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes G4 o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes r4 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 0 No ❑Don't know <br /> 7. Is this to correct a violation? /Yes KINo <br /> 11-57/ r •PPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -* - <br /> 545-112(4/08) <br />