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'it LP:76 , - I . - T 1 — ' • ' <br /> ZONING IT APPLICATION .countyofdane.com <br /> PROPERTY MINER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME am'` <br /> bed 1'/ ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street, ity,St a ip) <br /> / / Deed Restriction; CSM <br /> ((� Ste( :� �� E 9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3-?'.C.- I. <br /> Ai '. ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME• <br /> . 4 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRESS of well/septic <br /> (City,State,Zip) (City,Stat-,Zip) ❑ Setbacks <br /> PHONE PHONE El Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL A.DRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> El Elevation of property <br /> PARENT = CURREN ZONING ACREAGE:•❑ PARCEL r frontage drawn to scale. <br /> NUMBER h / Ii� �� i <br /> TOWNSHIP: - ■ SECTIO <br /> tE 1/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: ' ! (state,county,town) <br /> (.03 5 , ce�� L7!� v I ' S' 2 9 ❑ Sanitary permits <br /> CSM: LOT SUBDIVI'ION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION TAFr <br /> PROJECT DESCRIPTION: <br /> rc4 IU "Zoo PI- — I Ec k U Zone g Asti <br /> . ❑This project is a new building or structure. <br /> Use? <br /> This project is an addition/alteration to an existint building or structure. ; <br /> SANITARY SERVICE: PERMIT UMBER: Et Rural <br /> nSEWER SEPTIC ° � <br /> HEIGHT IN FEET: v.k., <br /> NUMBS'OF RIES: (Not including basement) ;'i.' i #a, h, f e e°°`h <br /> AREA TO NEAREST SQU' -E FOOT: Ala i <br /> (Outside dimensions including unfinished area,attached g. ages -nd above grade decks or porches) <br /> BASEMENT: 1ST FLO R: 1 ,' <br /> 's r �� TOTAL SQUARE FOOTAGE: 4, Cex) <br /> 2ND FLOOR: 3RD FLOOR: Zt Cr/ ,'7"1":# 4,04-• <br /> 'fit Sul <br /> y <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ .? D(Jo i a ' 9i op..y, <br /> (Please round to nearest dollar) ' -� =. ' U:0* <br /> 1. The property is within 300 feet of a stream or 10011 feet from a and r lake? Yes r No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro•erty? Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your proj-ct and are they in agreement'? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> Eyes No <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 2 N ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />