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, 7b <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME i <br /> // Ck(i e//e 4 .5(4104) 611W) ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 175-5/ CELL r"_47 d � E-MAIL A DRESS u W k 5 5( Variance(# ) <br /> HOME PHONE <br /> 08-'85- -7/2-7 14/C.Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGFT NAME CONTRA.TOR NA <br /> 9E <br /> 11 n 0t Mai 4 e .5'c",� 14(, '5-c I S t� 143C, ,°/�-%a' Site Plan including location <br /> AGENT ADDRESS ^� CONTRA TOR ADDRESS of w II/septic <br /> i 3 Sy 136, e '� <br /> (City,State,Zip) /J (City,Stata,Zip) 'Q etbacks <br /> e el ' ' ` �a Plan approval from <br /> PHONE PHONE J <br /> S.53/ 7G yr SO2 S applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> lo• plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: <br /> ACREAGE: <br /> ❑ PARCEL 0 7� 2. /�R —/ Z frontage drawn to scale. <br /> NUMBER J' SiZ $O - Z QC <br /> TOWNSHIP: SECTION:, 1 <br /> co,, € 2 Y 1/4: N u/ 1/41/4: N .6 riveway permits <br /> Coa (state county,town) <br /> ADDRESS: 5 <br /> OT DI <br /> I <br /> 4 anitary permits <br /> CSM: SUB ON BLOCK/LOT (public, rivate) <br /> 0 �7 �, / / (P P <br /> PROPOSED PROJECT INFORMATION '•.STAFF REVIEW , <br /> PROJECT DESCRIPTION: ' 1 � / <br /> N P w f/ , -i e ■ anlrtg District <br /> . a-This project is a new building or structure. emitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' • <br /> -traptgil SEPTI S Z 0 35' Z --, :'(new xisting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2" land/g'fao00. <br /> Z� Ii''�•)V" fioretands (attachment <br /> AREA TO NEAIitST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 1 <br /> vslonContrvl£ ermit <br /> BASEMENT: 1ST FLOOR: •Lk, 09 4, TOTAL SQUARE FOOTAGE: 4, (Slopes,disturbancre, <br /> 2.3 / 7 � y `� /fj�/v" fll(nglaceess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ('y// /0 l i,r °= few LacatiO Sxinre"y <br /> ESTIMATED CONSTRUCTION COST: $ and ava(Eaf5S 4 3�iC nS . <br /> (Please round to nearest dollar) "� $ I f°�a�Q . U C _l 3 ptions <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 a No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? lit Yes ❑No <br /> 4. Has there been a zoning permit issued for this prop' <br /> rop'erty in the past 5 years? ❑Yes 21 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 ria No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ;Y'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545-112(4/08) <br />