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• 5-.0S4 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW ER NAME <br /> 11 I f M/ l X '' Zoning tatus;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) g ' <br /> j 1 sr <br /> 3 ��� f ,e, Deed Restriction; CSM <br /> a Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 531/5-- r 37/ 2D/- 537/ RA„/,/ ( i"3 eTTS_ ,VE/ A Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ S Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS or II/septic <br /> (City,State,Zip) (City,-. , i.) Setbacks <br /> PHONE PHONE _ . Site n <br /> app ' ble township.approval from <br /> E-MAIL ADDRESS E-MAIL ADDRESS � <br /> ,.1; Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.w9.us/) �( Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: l-� p p y <br /> ❑ NUMBER W, --3//- 950D-J H -/ . s- 2p frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> V•t/A9,/ "/ 1/a: `7 F 1/41/4: NE ❑ Drive permits <br /> ADDRESS: (st ,c linty,town) <br /> 3// rr, �e.- - ( ❑ Sanit.,•, <br /> permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu• c, • ivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVI[EV1 <br /> PROJECT DESCRI TION: - <br /> �� 5 � Zoning�strretu <br /> . YQ I IIiS project is a new building or structure. It Permitted User. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: �/ PERMIT NUMBER: Rural s <br /> ❑SEWER ❑SEPTIC' k (rte xisting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I S A� = LS s,-7�.1 wear, t F)O ' ( lr1/ �� � <br /> fib a (attachment) , <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErC131C? 4 T� �#er�T16 <br /> ?�� f , TOTAL SQUARE FOOTAGE: j (Si•O)3eS [Sturb nnce, - <br /> D drill- cc SS ,'� <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2//i <br /> 001ew •c •ti SUrve <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ --► ♦ ♦ — and avail-•'a options <br /> (Please round to nearest dollar) �� k :5 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Cho ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes fro ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? .Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes O 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 Gi'No U Don't know <br /> 7. Is this to correct a violation? Li Yes Ci1Nfor <br /> APPLICATION MUST BE SIGNED <br /> 545-112 14/08) <br /> (Continue on Back) ■ -► <br />