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. <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jeff aMd 6Ue. \A ae►- XZoning Status. UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ` n Deed Re tr' Ion;CSM <br /> SZO I M A yo Dr. , 5,I fir_ Ill Mc ison, WI 5310 variance ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-8445-1550 608-695-022-4 J - , ,e real est+e, 'ann 1Site Plan dra oscale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includeg dimensions <br /> AGENT NAME CONTRACTOR NAME _t_ i L)a <br /> Co non S ACT Deve.►..oP Meit t Z o30 Af Site Pla_ n ' uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well ptic <br /> sflta+i. as at lOovti l'etimc AS Ailo <br /> (City,State,Zip) (City,State,Zip) ,i 1 I Set�i <br /> MACQt,5Dv LOT— <br /> PHONE PHONE ❑ Site Pjsn y�fp� �vaI from <br /> &o5 — 135/S"/55Z) eo - 845 °`S5o appli "'Nt,.. ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 5A1te 4S A60vie.- 5/i Kt_ AS AbD loor pl s scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of r ert <br /> PARENT PARCEL NUMBER: u CURRENT ZONING: ACREAGE: p y <br /> ❑ NUMBER 1J e�3Z`--4' l 0 A- i frontage a n to scale. <br /> TOWNSHIP: SECTION: - <br /> M Odle-ivy) '/4: %IA: ❑ Dtat /A,mi.wn <br /> ADDRESS: 1 ,3c1 Pe 1 '� \ ) <br /> 1 'kJ> Sanitary permits , 1 <br /> CSM: LOT r suBDlvl IoN BLOCK/LOT (public,private) 'TWO- ice) \ <br /> (v., M e.3�o��c.4'� <br /> L f <br /> PROPOSED PROJECT INFORMATION S F REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zonin D riot <br /> . '- This project is a new building or structure. L Perm ed Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ - al Address <br /> ID SEWER I� `, '-SEPTIC 71 C--).'17631) /existing) <br /> H IGHT IN FEET:j NUMBER OF STORIES: (Not including basement) <br /> je -2_6 ' / ❑ Wetland/71••• • ,in/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela ',1! . ent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> 1-f ❑ Erosio C C. I I permit <br /> 5 f D 5# 3/ -7 q I 0 5,0 4 TOTAL SQUARE FOOTAGE: ,� (Sb':1 v 4 ti'" " :, <br /> 2ND FLOOR: 3RD FLOOR: 7 7 �1u�/' F -P <br /> 8Z <br /> , 1- ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ (1 IS /-� and available options. <br /> (Please round to nearest dollar) $ 'i�08 OD v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ANo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑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? 1I Yes ❑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) -► -1 -► <br /> 545-112(4/08) <br />