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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU • ER TO PROVIDE <br /> OM ERR NAME A <br /> 1 A `t K� + W ey aL.1 GC C IN lining Status;CUP; <br /> ADDRESS Street.city.s�a Djeed Restriction;CSM <br /> too ` � r„.„,. 1�(.Q.lJ, % 535�a ri nce(# ) <br /> HOME PHONE CELL PHONE E ADDRESS <br /> 2_12023- 3L( t7 We • U.Y ti • , -•i., . Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a includes dimensions <br /> AGENT NAME CONTRACTOR NAME C �� <br /> \ „ n W> S e Plan indudi ng location <br /> AGENT ADDRESS COOLTRACTOR ADDRESS o 11 () well/septic <br /> 11 <br /> (City.Std.Zip) (City,State,Zip) (Setbacks <br /> rn� 00Ckb w. SS7 a <br /> PHONE a Site 'Ian app I from <br /> 7p 0 Li(D6( - 7 a-7 6j a•, ica ship- <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> i n\Ke• Q CW6SGAiklYbc (4 ! " •• plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessaane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER CUR-I: ZONI" ACREA Elevation of property <br /> [P RCER O COO 7—0 L(L1 --Cj -a 11- I a frontage drawn t le. <br /> TOWNSHIP: V a SE ' • : / <br /> nc, .e l v: 5 0- 'yy`_Z" I ❑ <br /> a rm <br /> its <br /> state un ty,.. :• -� [�•• OCR , Y ( % P% S35 7a anitary permits—Cell <br /> CSM: f LOT 'SUBDIVISION BLOCK/LOT (Oiublic,private) <br /> PROPOSED PROJECT INFORMATION . AFF REVIEW <br /> PROJECT• • • • : / b,i <br /> f r L • <br /> o ing District <br /> . ['This project is a new building or structure. ❑ Permitted --.. <br /> ETThis project is an addition/alteration to an existing building or <br /> Tr. <br /> ARY SERVICE: PERMIT NUMBER: Cl urai ' •dress <br /> ( <br /> HEIGHT IN FEET: i NUMBER OF STORIES: Not including basement) <br /> t <br /> -nd/Floodplain/ <br /> S • :,. • (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) • , OSioncontroi it <br /> BASEMENT 1ST FLOOR: -7 A�� 3 /5 j TOTAL SQUARE FOOTAGE: 4, slopes,disturbance, . 1 <br /> 2ND FLOOR 3RD FLOOR <br /> filling/access) <br /> v7S ` -75 0 1 <br /> Review Location Survey (])ESTIMATED CONSTRUCTION COST: ♦ S and available options. I <br /> (Please round to nearest dollar) l 0 666 1 v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? , Vo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Res o ['Don't know <br /> ,® <br /> 3. Have you talked with the township about your project and are they in agreement? Yes LNo <br /> 4. Has there been a zoning permit issued for this property in the pest 5 years? [Yes alo <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 o ['Don't know <br /> 7. Is this to correct a violation? ['Yes 0 o <br /> -417 �� APPLICATION MUST BE SIGNED <br /> 545-112(NOM ) 0 (Continue on Back) -► -. -. <br />