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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NA E <br /> 0 ° 5- 1 4-1-b 12 1,00 c ❑ Zoning Status; CUP; <br /> OWNERADDRESS ( , <br /> ber,Street,City,State, 1L ,y ]/ Deed Restriction; CSM <br /> 77 ° /J - {� I 7 / (,Jd/e/„, ii,--1_...511-5-6.2- Variance(# ) <br /> HOME PHONE CELL PHONE -MAIL A DRESS/ / <br /> 119vC3 ZL- 22g-7 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> c eAGEN NAME / CONTRACTOR NAM <br /> '(5 flphc1- / cc c(, �ifc lc L ❑ Site Plan including location <br /> AGENT ADDR SS CONTRACTORAD9t?ESS of well/septic <br /> 52i Stein �.1j5ef ' , 1 1 <br /> (City,State,Ai i i T W 5- 3 -6, _____ (City,State,Zip) ( ❑ Setbacks <br /> (JJt r1 � L <br /> • E / PHONE ` 1 1=1 Site Plan approval from <br /> .f: 22_?,-9 Z Y� applicable township. <br /> E-'AILADDRESS CLric,4-c-e-kC-∎ Mc-Lie E-MAIL ADDRESS ■' <br /> tin G i -c El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> I__, PARCEL t5, g a70�-o7y�os(3 L C _ 1 )- 4 (P frontage drawn to scale. <br /> NUMBER <br /> TOWNS I SECTION: <br /> rt t�P:� c F, ,� 5. w 1/4: 5 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 7756 U. c )1,11L- ' 1y ft.-,d ale - �r_ <br /> csM: OT SUBDIVISION f BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> 4 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEgT DESCRIPTION:,. 4 <br /> C. cc - ie,'v.t.S r 'j c J J - "Zoning riot <br /> `This pr ject is a new building or structure. F to <br /> O' �i£too U ' <br /> ❑This project is an addition/alteration to an existing building or structure. '� ''' <br /> s „ <br /> SANITARY SERVICE: PERMIT NUMBER: Ett* : (frBSS <br /> SEWER SEPTIC wl e�g) <br /> HEIGHT IN FEET: k NUMBER OF STORIES: (Not including basement) z , <br /> AREA TO NEAREST SQUARE FOOT: hor ch <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> r hro S�9 <br /> t �"` <br /> #BASEMENT: 1ST FLOOR:lY l�1.0 : ,,d • r r TOTAL SQUARE FOOTAGE 4, <br /> 2ND FLOOR: 3RD FLOOR: CP`�,j -, <br /> ill ' <br /> U Review # • Survey <br /> ESTIMATED CONSTRUCTION COST: Q� S' <br /> ♦ ♦ ♦ —� -� opt <br /> (Please round to nearest dollar) .p �s � ," 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes , No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes .rNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ,JYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ,,No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# Z�3 y ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Vo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> 545-112(4/08) <br />