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* a-70 <br /> .Z01IING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> V&rcJ Ae- KV kQer-' f ❑ Zoning Status;CUP; AC— <br /> OWNER ADDRESS (Number,Street,City,State, ip) / / Deed Restriction; CSM <br /> 711 9 6 - /11.A f ell odic-. Lc) 3 `F Variance(# ) <br /> HO ■E PHONE C L P ONE E-MAIL ADDRSS <br /> / a to-y 315/ Os 7/02 co( ❑ Site Plan drawn to scale <br /> \e/AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> sionQ <br /> AGENT AME CONTRACTOR NAME if <br /> crock, Q ,(cln Coc ❑ Site Plan including location <br /> AGENT ADDRESS n CONTRACTOR ADDAESS f well/septic <br /> 71 t ct Coc it ,A Rei 1 Po Pc«l z s4 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Iet(c-0 � e. l)< 53‘og \,)tcotiri <br /> r �� s3c '3 <br /> PHONE r PHON <br /> ❑ Site Plan approval from <br /> A � /- c 3 7.3 -SScV applicable township,. <br /> E-MAIL DDR E-MAIL E MA ADDRESS <br /> Floofflans to s le <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) t�j 9 r•�4''�' <br /> PARENT PARCEL NUMBER: //� 2CURRENT�ZONING: ACREAGE: ❑ Elvation of property <br /> ❑ NUMBER �0/d SG �fGW 3 (.- ( r�O onta a drawn t scale. <br /> TOWNSHIP: SECTION: t <br /> ('�on-F rGSC- e2 7 1/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state,COUn town) <br /> 1 t ket •elitiA a ee I/wirk l�,. S3( ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private)Ne1 <br /> PROPOSED PROJECT INFORMATION STAF REVIEW <br /> PROJECT DESCRIPTION: Et F a t V <br /> U Zoning,District -" <br /> . This project is a new building or structure. ❑ Permitted User <br /> ❑This project is an addition/alteration to an existing building or structure. 11r <br /> SANITARY SERVICE: PERMIT CUMBER: <br /> RuralAd'• s <br /> ❑SEWER ❑SEPTIC (r1;ew/ Isti y' v <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Wetlan, ,F190d 6 a i ` . <br /> I R Q.3 C-�c-se o Ile ore4p s a ,c op.,,,t - - "i <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached ga-ages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ECOS1or1GOl,rol-)7grrriit <br /> TOTAL SQUARE FOOTAGE: (slopes,disturbance, "�a ' <br /> filling/acCess)� <br /> 2ND FLOOR: 3RD FLOOR: " <br /> 1q go ❑ Review�Location Survey <br /> ESTIMATED CONSTRUCTION COST: 3� ��� c;' tudavailable`0 OfS <br /> (Please round to nearest dollar) I i ,e „ <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 ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? l Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes C$No <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if ne) <br /> l6. Is a location survey required? (see reverse) ❑Yes �®No ❑Don't know <br /> 7. Is this to correct a f Fatiori? Yu es �No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —* —► <br /> 545-112(4/08) <br />