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ZONING PERMIT APPLICATION www.countyofdane.com !Zra==iiiii=3:1 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 1"', <br /> /4)4k) K SG'..1 L A-) 2,Zoning Status; CUP; � (� <br /> OWNER ADDRESS (Number,Street,City te,Zip) ,---„ r> Deed Restriction; CSM w <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI ADDRESS <br /> &(--:,-:. 764-.)/5. C,c - ,,,.-/z2,-- /: ; / <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT.'ACTOR NAME 1ll <br /> D��> i4, w�'Gl --� 2c L L,✓ t'��c L Site Plan including locatio <br /> AGENT ADDRESS CONT.■CTOR ADDRESS y)4!4.)i��rsti of well/septic <br /> (City,State,Zip) (City,Sate,Zip) 154 Setbacks Aw I ' Q► ' O <br /> PHONE PHONE 2 ite Plan approval from 4i.2 C) applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS) <br /> al ft -, ?i:vcti j cot-'.C'c"1 Floor plans to scale <br /> PROPERTY/LOCATION "INFORMATION (httny!;zccessdane.co.dane.wi.us/) <br /> 4 <br /> PARENT NU7,2) RR NT ZONING: ACREAGE: Elevation of property y W <br /> ❑PARCEL / • •- ��✓ O I( Z ci —z G�g /t (0 NUMBER ontage drawn to scale. <br /> TOWNSHIP: • • ION: <br /> 144i.ft f)u A 07 '/4: A)(0 '//%: i'd PPri ay permits <br /> ADDRESS: county,town) <br /> 6, <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Sanitary ■, -• <br /> /c;C/Q -j — — , publi•,priva t:• <br /> PROPOSED PROJECT INFORMATION <br /> '2 � ` <br /> STAFF F REVIEW <br /> PROJECT DESCRIPTION: ► / wZonin IS W <br /> . <br /> 2 C 7o _rJ c kUl►"-d S;C-`/i-1 7l K� rO G <br /> . <br /> This project is a new tttpilefirrgef structure. Permittecwse? <br /> This project is an addition/alteration to an existing building or structure. f' 00 <br /> SANITARY SERVICE: PERMI-NUMBER: tea" <br /> EWER. KEPTIC t►"' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> horeland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Z FroSiOnCU7trt1 it <br /> BASEMENT: 1ST FLOOR: O perm <br /> r- <br /> 4, TOTAL SQUARE FOOTAGE: 1 .,(�,dist ance, <br /> 2ND FLOOR: 3RD FLOOR: _ fi�'acx.S .` k / <br /> ESTIMATED CONSTRUCTION COST: y ell hevie won rvey <br /> ♦ ♦ -► ♦ ♦ ♦ J C 7 ,t). aTld aii�al� E; � <br /> (Please round to nearest dollar) $ ► �" <br /> 1. The property is within 300 feet of a stream or 10 0 feet from a pond or lake? ❑Yes alo EDon't know <br /> 2. Is there a wetland or floodplain on or near the pr perty? ❑Yes fNo ©Don't know <br /> 3. Have you talked with the township about your pr •ect and are they in agreement'? [Yes f j io <br /> 4. Has there been a zoning permit issued for this pr perty in the past 5 years? gYes ao <br /> 5. Is this project associated with a rezone/CUP/vari nce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Ekes 1 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes IA o , <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -+ ♦ - <br />