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ZONING PERMIT APPLICATION uww.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> `c///t, /Q/J/l� ,�trbaret ccn°e I ❑ Zoning Status; CUP; <br /> OWNERADDRESS (Number,Street,City,State,Zip) G Deed Restriction; CSM <br /> 5-5 `ice (/Q��e�/ /�per< ) ,Rretdi Jyhl Wl J�-3s Z —�y � Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6vB-X35=5�9 -57�-282 '� �.- <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME / CONTRA'TOR NAME D jj Or <br /> ,u <br /> ,f'��// •Jo Htti 4 q Qe e.�e�%rte Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> V27 /DIESY 7L,iNDe Sic— <br /> (city,State,Zip) (city,stat$,Zip) 1=1 Setbacks <br /> De f Re'-mot- 47/ 53 3-3 2 1,g "5-Y--,..‘ �i .S-?r 9Z <br /> PHONE PHONE 1 l 1=1 Site Plan approval from <br /> 6 de eye 3 S-Q8 Go qy(- .7f applicable township. <br /> E-MAIL ADDRESS E-MAIL A DRESS <br /> �-�/��to inAt r�.Cep? ff 4.-ev 'm ail co El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ElPARCEL DSOS�Z7Z'U. 3 b/��/ 3 , (7"8 frontage drawn to scale. <br /> NUMBER DC [, <br /> TOWNSHIP: <br /> SECTION:I <br /> ��/J 2-7 l/: A// y": /�W 1=1 Driveway permits <br /> ADDRESS: (state,county,town) <br /> �"S 8 Fc h o ti ley 2d. _/-00� ", ry� S 3�Z! -Q Li iii <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> /p (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 3u �-oK-t d�a�f ch to fq�r.��a+a� uNV�R �r�st/N� ICoc(ea tie CI Dom'. <br /> . ❑This project is a new building or structure. " <br /> WThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER. 0 Rural Address <br /> SEWER SEPTIC <br /> HEIGHT IN FEET: NUMBER 4�F STORIES: (Not including basement)65 . t. I <br /> ) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached ga ges and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR:'" <br /> /vatrlp 3x 20 1 TOTAL SQUARE FOOTAGE: 1 ffi. <br /> 2ND FLOOR: 3RD FLOOR: �'d <br /> aftevL.loti; oD fey <br /> ESTIMATED CONSTRUCTION COST: _, — ♦ - + --► $ /0i COO <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000feet from a pond or lake? ❑Yes ©No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ICJ No ❑Don't know <br /> 3. Have you talked with the township about your prof t and are they in agreement? Yes ❑No <br /> 4. Has there been a zoning permit issued for this procerty 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 /> APPLICA MUST IGNED <br /> (Continue on TION Back) BE S <br /> 545-112(4/08) <br />