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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 /> Dar re I - S h e' a, I " "U,r O Zoning Status;CUP; <br /> OWNER ADDRESS (Nu r,Street,cit state,Zip) .1 .R , J,� Deed Restriction; CSM <br /> 2J V v ov- �O i S2 S ariance(# ) <br /> HO E PHONE CELL PHONE E-M IL ADDRESS <br /> �� , �°I 'o t(�- 4 xi" 8 �l so.t 355 p cl ctr{er,h4k Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a includes dimensions <br /> AGENT NAME CO TRACTOR NAME .• .e c eq %•"s..■ <br /> Co�(+.ct ) ite Plan including location <br /> AGENT ADDRESS ��f� C 1 g Ifli.DDR 1 Kr\ St, well/septic <br /> (City,State,Zip) J �+` (City,State,Zilpp))I/ t��//Il etbacks <br /> of-125o"\ V1,—.C1 S3 51-5 <br /> PHONE PHONE / ❑ Site Plan royal from <br /> " a OSLO g °�ce a li e townsh' <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ loor ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRE ZONI G: ACREAGE <br /> ❑ PARCEL 04 g /0509„` pZ-x�p'a . R frontage drawn to cafe. <br /> NUMBER / <br /> TOWNSHIP: SECTION: <br /> • Of. CJ O V og 1/4. N w 1414: N vd ❑ Drivewa ermits <br /> (st ,county,town) <br /> ADDRESS: �2 <br /> 13 5S l itev3"\ TR . ❑ Sa ' ry permits <br /> CSM: ,<?O LOT I SUBDIVISION S BLOCK/LOT •IIC,private) <br /> .1 <br /> PROPOSED PROJECT INFORMATION STAFF`REVIEW <br /> PROJECT DESCRIPTION: / ax <br /> OtboA (t - 1p e I ; y, ,k`�.�„,a <1 fing District <br /> . ❑This project is a new building or structure. Permitted Use? <br /> 1IThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUr ' •+re <br /> (Ile /existin+ gg <br /> ❑SEWER SEPTIC z <br /> HEIGHT IN FEET: - / 1 / NUMBER OF STORIES: (Not including basement)z_i=�'� S and-(attachmen <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ �roeionyo .permit <br /> BASEMENT 1ST FLOOR: <br /> / 4 TOTAL SQUARE FOOTAGE: j, (Stops ,turb ce, <br /> Mitt .• access); <br /> 2ND FLOOR: 3RD FLOOR: Z1 5'' Ri 1 r__:, <br /> Review L.aeat►on Surrey D <br /> ESTIMATED CONSTRUCTION COST: $ S Cz V n �� ' and avaltabte?options <br /> (Please round to nearest dollar) ♦ ♦ ♦ --0 --► ♦ / x .. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑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? ra Yes ❑ro <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blan none) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> 1 <br /> APPLICATION MUST BE SIGNED <br /> 4-/ (Continue on Back) —► ■ —► <br /> 545-112(4/08) <br />