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, <br /> . , ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to web-App# <br /> w► <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROV E <br /> OWNER NAME <br /> C Q J J <br /> St ` ` I I1 Zoning Status; CUP; <br /> OWNER DRESS (Number,S et,," State,Zlp> / /� / Deed Restriction; CSM <br /> lei `(� ! 5��C.f v��1 kvl 17) 1 6—)41414 r l ,�'3 f,. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS / <br /> (pOf—Tye-y25 ' (vow-7��� ' cic� 4 i c 1, , — ••; a <br /> s Site Plan drawn to scale 2� <br /> AGENT INFORMATION CONTRACTOR INFORMATION _•: includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> _ �t LAC=/G1 f 7� �►� Si -.-�r.- .uding locati. <br /> AGENT ADDRESS CONTRAC1ORADDRESS � ,c` <br /> (City,State,Zip) �r ► /% /�r �I� <br /> (City,State,zip) Setbacks <br /> PHONE PHONE `� i Plan approval from <br /> applicable township. I <br /> E-MAIL ADDRESS E-MAIL ADDRESS / ,, //� / <br /> I�:1 Floor plans to scale • <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/ +/ <br /> PARENT PARCEL NUMBER: C RREN/T ZONING: ACREAGE: I.-1 levation of property �� / <br /> 0 NUMBER (3 L V%_0 t1 -L�QQ v yZ�� `� ontage drawn to scat:. <br /> TO SHIP: SE(TrION: _ <br /> 6- i-4-/—/ (o 1/<: �' '/<'/<: �' Driveway permi �� ,4 <br /> AD R ss: , state,count <br /> CSM: LOT SUBDIVISION BLOCK/LOT rill Sanitary, u s //0 "0A Z <br /> (publ ,privat- <br /> PROPOSED PROJECT INFORMATIONS�. <br /> PR JE T DE CRIPTION: t /40 �oc hL v i F'4 ` 9 1 <br /> ❑This project is a new building or struc ure. , <br /> This project is an addition/alteration to an existing building or structure. � � <br /> SANITARY SERVICE: PERMIT NUMBER: d'�) <br /> EWER PEPTIC / <br /> HEIGHT IN FEET:/ NUMBER OF�TORIES: (Not including basement) <br /> AREATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR : - ',. � ,; <br /> (}(� TOTAL SQUARE FOOTAGE: n �� z�a ` t �/ <br /> 2ND FLOG 3RD FLOO ' ��� <br /> (Please ouDnnd to nearest doll0;COST: ♦ ♦ ♦ ♦ ♦ -► / a o�� p i v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives �No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lives o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ]Yes �� 0 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> oyes ®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) Lives �No QDon't know <br /> 7. Is this to correct a violation? QYes [�/No <br /> APPLICATI MUST BE SIG NED <br /> 545-112(aios) <br /> (Continue on ON Back) -► <br />