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g 6,0 ,1;(3 <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME /— <br /> I q0t-1S7 <br /> n Zoning Statu , CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed ' st action; CSM <br /> 6y3fv $v1Sr7 Op-■_' C ( (/.c/2-oni� / t..1 53S53 Varian ) <br /> HOME PHONE CELL PHONE E-M IL ADDRESS <br /> (o' 32a -0232_ '-o,- iLt-0 C cy, 1,vo - ❑ Site Plan drk o scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n Site Plaqipt6ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/sptic <br /> (City,State,Zip) (City,State,Zip) ❑ Settpks <br /> PHONE PHONE ❑ Site Plc n . . royal from <br /> applic ,'.ro, hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor pla to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) 111 Elevatiolfoperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El NUMBER CC 2-!/D6 cq_3 / -104-3) 2/-f-3 /0. 60 frontage drawn to scale. <br /> TOWNSHIP SECTION: <br /> E6-o4/4 1�4. /1/. ❑ Drive a is <br /> (Stae town) <br /> n) <br /> ADDRESS: <br /> G Y 3G S(,,,t a 0,- <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ 1p%.i <' '.ermit v <br /> i <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �,T S3 I 'C- "c-Lc G F'• '' <br /> l 57 ?to t.):1— II-G- 0c.-L, 13cva60w 41:0,J(po 61-714 4DA Pc a-i ❑ Zoning is ct <br /> . ❑This project is a new building or structure. Li Permitte se? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> SEWER FSEPTIC (new/etti)) <br /> HEIGHT IN FEET: // ,, NUMBER OF STORIES: (Not including basement) �� <br /> I Z ❑ Wetlan Fj•}•I-in/ <br /> C rdht et-c( Shores (.tt. hment) <br /> AREAO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosio C.n of permit <br /> 1 q li 4, TOTAL SQUARE FOOTAGE: ,, (slop;'. •is nce, <br /> 2ND FLOOR: 3RD FLOOR: ( !� flllln• acce s) <br /> /114. l ❑ Revie •Itio• Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and al.,. e •ptions. <br /> (Please round to nearest dollar) <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 12 No n Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [TNo <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) n Yes ❑No n Don't know <br /> 7. Is this to correct a violation? ❑Yes allo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> 545-112(4/08) <br />