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ii 3 v� <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ' <br /> -24 (\)(5 '61M ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ,- I <br /> �I ,J . �l/ I A so vt 33s4� Deed Restrictio SM <br /> 't�yz R SCen i o V i et,� �y(�t 1 Variance(# l� ) <br /> HOME PHONE CELL PHONE r1 �/ E-MAIL ADDRESS <br /> 1g-2z5-7„IA as •(\olae.n , • IM,• it .60 ❑ Site Plan�ray�to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site PJn� ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of we /N sL Ic <br /> (City,State,Zip) (City,State,Zip) ❑ Setba <br /> PHONE PHONE ❑ Site Plan '• s r al from <br /> applicab t •ufins'#�ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plarylj;.t� <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) //`�' <br /> PARENT ;ARC El EL N MBER: CURREN ZONING: ACREAGE: Elevation of•rix erty PARCEL '❑ <br /> NUMBER 09/0 1 3 - 41.317'° frontage/. . t► scale. <br /> TOWNSHIP: SECTION: <br /> UK. t 14(15 '/4: 1/41/4: ❑ Drivew y s <br /> ADDRESS: GG `' �� <br /> (state, u t ,town) <br /> LlL1 Zq 6c�1 C v : ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (• • c,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: `11%ri' <br /> _it roo."- I �op ` / . ,.. € . <br /> ❑This project is a new branding or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. q-.&11111,; <br /> SANITARY SERVICE: SEPTIC PERMIT NUMBER: al-A.0 ` £ <br /> f 1 ... °>s x '' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gatages and above grade decks or porches) " <br /> BASEMENT: 1ST FLOOR: <br /> j 4,TOTAL SQUARE FOOTAGE: if •• 7 . •a , <br /> 2ND FLOOR: 3RD FLOOR: O <br /> ESTIMATED CONSTRUCTION COST: ••t <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ _9 ♦ $ 10 1 606 , 00 t,'/O,,,,,,,- , , <br /> 1. The property is within 300 feet of a stream or 100q feet from a pond or lake? ❑Yes [KI No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes a No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes E 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 [Qa 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 />