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• <br /> 1+3-7 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME , 1 S[ <br /> OWNER DAD DRES uCL. r,Str e,city,state,Zip) Zoning Status;CUP; <br /> Deed Restriction; CSM <br /> V f�?co 8€r'�Q c)1c f Lock/ i dr (Q (0!) to : 5-s5-6d Variance(# ) <br /> HOME PHONE CELL PHONE -MAIL ADDRESS <br /> IU -g. -)-A• •• ,- -/1 N m , ha 5(corn, j, , ,,t5b:0,C044 in Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C/part/ R�;14 A CO('10 14 Site Plan including location <br /> AGENT ADDRE CONTRACTOR ADDRESS J of well/septic <br /> MO Poo 1 : Sf VQ co n0.GO.7 535-9i <br /> (City,State,Zip) City-State,Zip) ‘Setbacks <br /> PHONE PHONE ❑ Site n proval from <br /> / -WO - 37 S - SSi O applica township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 3 --(`. 4 A� 1 F l o o r e <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p ro p y <br /> ❑ PARCEL 0g0e i+60 v 1� )�t�� frontage drawn to scale. <br /> NUMBER 'b �6 IJdJV � <br /> T NSHIP: SECTION: <br /> 30 1/a: ,S L ) 1/a1/a: SC.� Drive ermits <br /> �I; �� � (stat nty,town) <br /> ADD ESS: //�� (, <br /> 787 (Ct A-4- m Pdn4 �'Cr�,` t >n')idlo 1Q(CA LOT 535-.) 4San - •ermits r-t <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pub private) Jt'`S <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRf( JECT DESC TION: {� <br /> f'Os f- cc - w 50:(u o ti� Zoning Districf � ' <br /> . ®This project is a new building or structure. a 'y <br /> Permitted Uses = <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: oral Ad s r i <br /> ❑SEWER ❑SEPTIC (ne. x1' rl+ , �� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) i/ , <br /> 07? Wetla % .o'070gP 5 <br /> Sh• d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> COS c::tFo.permit <br /> BASEMENT: 1ST FLOOR: , <br /> ,, TOTAL SQUARE FOOTAGE: ``('rope , 1&tt tancettt4 t• <br /> 2ND FLOOR: r` 3RD FLOOR: / ry <br /> ( 0 Review ' catfah Survey <br /> ESTIMATED CONSTRUCTION COST: $ n ,and II .10.031,90s.: <br /> (Please round to nearest dollar) ♦ '--P --* --► ♦ ♦ $ ,a"I ( �©� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IA No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? pYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®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 kiiNo <br /> APE SIGNED <br /> (Continue PLICATION on BacMUk)ST B-i <br /> 545-112(4/08) <br />