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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to web•App`# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAM l <br /> I l Z eei4-�r &r oning Status;CUP; ,/ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 3 t <br /> �1 �� / r Deed Restriction; CSM <br /> 7 attC Ci-R-AP_ YG1V'_y,Son tv. Variance(# ) <br /> NsME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0.8--- F?^ 2 Y , �4 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions f i© <br /> A T NAME (�� �, 3NTRA(rciraimAmE ) // Suan 5 ci\m er 3 / / a6 Site Plan including location <br /> AGENT ADDRESS J CONTRACTOR ADDRESS of well/septic <br /> 2u0 7 AJi s7- /04 r <br /> (City,State,Zip) (City, tats,Zip) P4( 15 0 Setbacks 30`2. -0 <br /> © S 5352F <br /> PH E C,S_ PHONE <br /> , Site Plan approval from <br /> _____.___ ...applieerl,Fe-town.sNp. fi/41--- <br /> E-MAIL ADDRESS E-MAILADDRES � 1`/ <br /> Si L' ec , `, di, 0/Floor plans to scale cf <br /> PROPERTY/LOCATION INFORMATION'. (httpa//accessdane.co.dane.wi.us!) r 7`0 <br /> PARENT Elevation of property <br /> ❑ NUMBER PARCEL <br /> 0,5-6Uo o9-- 1–I1�1-, RENT NING:/ ACREAGE: 0� <br /> PARCEL � frontage drawn to scale �p- I/ <br /> TOWNSHIP: SECTION: JJ <br /> e Z ./: /�F WA: Ais Driveway permits <br /> 4. r 4 4. �- <br /> ADDR S: � . .. 7,"'" 11... <br /> 75-1/9- od' Ofvi- O <br /> CSM: LOT SUBDIVISION —BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAF" I , <br /> PROJECT DES RIPTIO –'�_!_ �� �'" " <br /> 5 /� – _��–�. =" ;mss: P-'1-5_.:";-"` e 6-,s r a ' r3 <br /> MCI i'./ :� .: t >�, <br /> 111 This project is a new building structure. 9`1 <br /> This project is an addition/alteration to an existing building or structure. r=� i <br /> SANITARY SERVICE: PERMITNJMBER: J + ° c; d <br /> (SEWER SEPTIC 1 -.1.n,---- 4-c <br /> -7 ,-u ,'''7x cu ', us-,1', -, <br /> HEIGHT IN FEET NUMBER OF STORIES: /(Not including basement) ' mo=t + � ? <br /> (/ jEl, ePi,5 ape e g : h' / 1) <br /> — Are 1- <br /> AREA TO NEAREST SQUARE FOOT <br /> r –O - .ej <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or port c OS e C°D A <br /> BASEMENT 1ST FLOOR /0 S` . TOTAL SQUARE FOOTAG 7. _o e d1S i A e efa ^r <br /> r i_i e a SS ,- , <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: �q�. � <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ -+ $ ,2 l�C K) _00 - ; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes O No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? E]Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes . LI No • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes 15zi 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 /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) –► 4. <br /> 545-112(4/08) - - <br />