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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 C p A. £2--� `` ` A--/�)( <br /> JJ h /V oning Status; CUP; <br /> O E ADDRESS Number,Street,City,State,Zip) ✓ eed Restrictio SM <br /> HOME PHONE �L O fiy �L'�IOIA, "..w4y� 'T7 . ,vii <br /> b O G - S /,;,c2 i ADDRESS ,8°N.6-€ 1�1 1 /, ' <br /> II Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes d. ensions <br /> AGENT NAME CONTRACTOR NAME <br /> 'A • •_ • cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS •' well/septic <br /> (City,State,Zip) (City,State,Zip) 14 Setbac Cl S ' 9 2/.4_.c/ <br /> PHONE PHONE ,�/ Site Plan approval from Si <br /> applicable township. �� - <br /> E-MAIL ADDRESS E-MAIL A•DRESS <br /> jM Floor plans to scale / <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) Elevation of property �� <br /> PARENT JEr NU LRf� CURREN ZONIN ACR G P P y❑PARCEL �1 .-- / ~( �0�� I � C � rontage drawn to scale. <br /> TOWNSHIP ` SECTION r�^^ <br /> TI ,/4. s h 1/1/4. cE ,►.v! Drivewa mits <br /> ADDRESS: (State, •• town) <br /> ,--..--e--- eSanita •- u its <br /> CSM:f1n N LOT SUBDIVI ION BLOCK/LOT <br /> 7 UX (publit� <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: t ' ` L <br /> o SV1, MIN 1 <br /> ❑This project is a new building or structure. ✓'' -� p�f ' 4-o <br /> This project is an addition/alteration to an existin building or structure. Q�h- � � � <br /> SANITARY SERVICE: PERMIT UMBER: <br /> (��� <br /> ••EWER V•EPTICr �er ' <br /> HEIGHT IN FEET: NUMBER•F STORIES: (Not induding basement) <br /> AREA TO NEAREST SQUA"E FOOT: , ;b ' <br /> (Outside dimensions including unfinished area,attache ga ages and above grade decks or porches) ;Y, <br /> BASEMENT: 1ST FLOOR' h �� <br /> / ♦ + TOLLS.,RAF• ∎TAGE: + j <br /> 2ND FLOOR: l7 3 3RD FLOOR: a <br /> ESTIMATED CONSTRUCTION COST: _ <br /> (Please round to nearest dollar) -► � � 4 "` <br /> 1. The property is within 300 feet of a stream or 100 feet from a pond or lake? Elves E io EDon't know <br /> 2. Is there a wetland or floodplain on or near the prop rty? [Yes Erlo ❑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 pro erty in the past 5 years? [Yes ❑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) Ekes slo ❑Don't know <br /> 7. Is this to correct a violation? -' ❑Yes Ilo <br /> r c/ APS BE SIGNED <br /> ,...$4.' <br /> (Continue PLICATION on BacMUk)T 4 <br /> 545-112(4/08) <br />