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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU •TOMER TO PROVIDE <br /> OWNER NAME <br /> ° C4 -T2 C Nr•iCorn IZ 2 . Et Zo Ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ed Re triction; CSM <br /> 6'0 /°"( 5 /34,0,169,p , h/. aria e(# ) <br /> HOM PHONE CELL PHONE E-MAIL ADDRESS <br /> .," �76c A Sit Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /YCl� )0/1/re.✓ //47uf� 22vc roe S A74) LiC ite an including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w II/septic <br /> G✓6.' I( irZS/.- 'J iv Sc I (4-1.4‘k f70 <br /> (City, te,Zip) (City,State,Zip) ❑ tbacks <br /> /nyf( pit ys p(?, /v ;rfl Z I�31 f S� <br /> PHO PHONE ' ❑ ite Plan app al from <br /> �g 7N�-S�K e� Og - 7 --x0 y a licabl wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 7jayi.ire,,,1elc 9a,raS!ho t i - ' . oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levatlon of property <br /> PARENT LPA'RCEL NUMBER: CURRE ZONING: ACREAGE: P P rty <br /> ID NUMBER Ql* i0' - 3 , 2 4'7 frontage drawn to sc . <br /> TOWNSHIP: —13,2 SECT I C <br /> DV /Al '/a: v '/a'/a: ❑Driveway per s <br /> ADDRESS: <br /> (state,co ,to <br /> (9 0' 6./c}A8ose- A-ve ❑Sa 'Wry p- its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> /O , avr3‘,s+-- 4'4. j !Z (pu•lic, • vate) <br /> PROPOSED PROJECT INFORMATION '• p Review <br /> PROJECT DESCRIPTION: P J Li) 1/J 0'r .- `'t" 1t2° C S ❑ - . ing District <br /> . his project is a new building or structure. II 7 ermitted U = <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ,Ural ®® ' <br /> EWER PEPTIC /fl9WI 1 ° <br /> HEIGHT IN FEET: r� ( NUMBER OF STORIES: (Not including basement) <br /> `�xJ <br /> led a ••a a lain/ <br /> horela a• (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) /Erosi Control permit <br /> ASEMENT: r�-�— 1ST FLOOR: <br /> (2-U `-mss,,, /1 t)_cO j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, ) <br /> J f lling/adcess) v/ <br /> 2ND FLOOR: 13 i 3RD FLOOR: _�I /6 <br /> X651(1 _ Q Review Location Survey I ,3> <br /> ESTIMATED CONSTRUC ION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q and available options. <br /> (Please round to nearest dollar) $ 370, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? V, es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? u es ; , o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes MI i o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes .lo <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) Elves liNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes gNo <br /> 545-112(aioa) 3___ 0 APPLICATION MUST BE SIGNED <br /> (� (Continue on Back) <br />