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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 33 4' 8t1•e Q-C ki e.) <br /> C�t I ( oning Status; <br /> WNER ADDRESS (Number,Street,City,State,Zip) <br /> 35 '� 3. CELL PHONE �i��tv re,LL ES S S9 O <br /> Variance Status;e\CSM ) <br /> MCf01E PHONE Wa✓lc PHO E-MAIL ADDRESS <br /> 608"(i91-'83.2, 60 g-3ss-7-/6Y hiatiimao -yea/ /,c.c,v1,7 <br /> pare—Plan drawn toscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 0 ,a . 714 54--0_1 I roc) Ou rr2.6eS ❑Site PI udin loc ion <br /> AGENT ADDRES CONTRAC OR ADD S <br /> 7/sept'c(City,State,Zip (City, p) ks <br /> PHONE PHONE ❑Site PI royal from <br /> applic a wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ration of prope <br /> PARENT PARCEL NUMBER:S 1' Cj�p� / CURRENT ZONING: ACREAGE 5154e P p <br /> NU BER a��/©Si(-� — r`'`��lo .-- �Igq 5,g A-: frontage drawn to sca,- , <br /> TOWNSHIP: SECTION: •1 <br /> SE h,1 : 5 ❑ Drivewa mits o <br /> Su.� Yt�tJiQ� 0 /4: a <br /> ADDRESS: 1 <br /> (sta ty,town) <br /> rc- <br /> 3S'} 1144 I2 S),A_l IfC�( IrlQ SS—CC/0 San permits <br /> CSM: LOT / SUBDIVISION SLOCK/LOT❑ P <br /> ,A , AL (pu•lic, ,rivate) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 6b xi 6 7Goi foray 4 Ai ,, r€? bou IL Zoning District <br /> . This project is a new building or structure. ak ermitted Use? <br /> /❑This project is an addition/alteration to an existing building or structure. <br /> /SANITARY SERVICE: p (� PERMIT NUMBER: ❑ Rural Address <br /> / EWER �EPTIC / i F J • (ne -'is ing <br /> ���/// HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 10 ' I ❑VC/ettt It p In/ <br /> AREA TO NEAREST SQUARE FOOT: S�F O and tachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1 ❑ ErOSI o I permit <br /> - / ,/` I 4, TOTAL SQUARE FOOTAGE: 4, (slopes rbance, <br /> t w Slf' TTT filling cress <br /> 2ND FLOOR: 3RD FLOOR: (/ /� <br /> /l a/6 ❑ Revie i -•c, '•• urvey <br /> ESTIMATED CONSTRUCTION COST: -10. -1. —• -► —0. —• and - , a• . •pti0 <br /> (Please round to nearest dollar) $ // it0D, 0o <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [lies alo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes 'lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Efres ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? OYes ao <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 �Jo ['Don't know <br /> 7. Is this to correct a violation? ['Yes ISO o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -0 —0 <br /> 545-112(4/08) <br />