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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 /> Joe ��e } ❑ Zo ing St s; CUP; <br /> OWNER ADDRESS (Numbed Street,City,State,Zip) ed striction; CSM <br /> 29/6 5,v/'IWel R,ose 2 0 Vtcor—y wx— _ <br /> HOME PHONE CELL PHONE E-MAIL S arl Ce(# ) <br /> g`/s 2Z07 6c e23s- 7 I -y/,vys cLdi,e pIQ lc�-(7Zcr.c/sc cr,, <br /> Si Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d in ludes dimensions <br /> AGENT klAME CONTRACTOFj,N�M /I g <br /> 4/'/ c r«' S r N �'_Tl ❑ Site Ian including location <br /> AGENT D ESS _ CONTRACTOR 4DRESS of ell/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan prov m <br /> 60g eq5^ aac 6752 a3 ap • et ship. <br /> E-MA ADDRESS E-MAIL ADDRESS <br /> rt r ❑ o laps to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT <br /> p�' CURRENT NING: b ACREAGE: p p y <br /> ❑ NUMBER ©60 v -� / 1 -MS' Z �` frontage drawn to tale. <br /> TOWNSHIP: SECTION: /�� n/ ❑ DriveW ermits <br /> 1 /7✓�/\.!- /-/ 1k i � /1/4:x' 1 U) (stat ,county, •Wn) <br /> ADDRESS: <br /> r Rose a{ ve✓%�-t G ti <br /> r- <br /> /G S ' ` / ❑ Sanit- permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT Z2. l (p •i•C,private) <br /> /PROPOSED PROJECT INFORMATION TAFFtREVIEVfF <br /> PROJECT DESCRIPTION: ® „:.,:::11,1:::::5:7.80,:v„;,. <br /> t t WC�■G� tg <br /> �` u/G aping DIstrtct <br /> This project is a new building or structure. <br /> c p f g r Permitted Use,70 <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: 'SEPTIC Ne PERMIT NUMBER: ❑ /Relt14 ' ” S <br /> ❑SEWER (new xistirl° "r <br /> r � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /o I ❑ Wetland F F .®••lain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorel '® (attaG nt) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) a , qr <br /> BASEMENT: 1ST FLOOR: ❑ CaS10n • Tol pefmlt <br /> Ai' Q I /A 4, TAT-41.-SQUARE FOOTAGE: 4, (510pe •FSturbari0e, <br /> /" ( aT fillip. .cress) e C)2ND FLOOR: 3RD FLOOR: mG a t <br /> . ❑ Review ii:6o on;Surue `v` <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --0. ♦ -► �+ and available options <br /> (Please round to nearest dollar) $ p�, V t 3 <br /> I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 0 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ares ❑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? L3 Yes <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -, -► <br /> 545-112(4/08) <br />