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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> CUSTOMER TO PROVIDE <br /> OWN E <br /> o^NE��+ Q srn r,,Street,City,staatte, �61 e Zoning Status;CUP; <br /> 9 //min q 5 ��y� ��..� �, • i 53 Deed Restriction;CSM <br /> OM HO CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> AGENT INFORMATION CONTRACTOR INFORMATION a and Plan drawn to scale <br /> . NT NAME and includes dimensions <br /> CO ACTOR NAM <br /> An Ie C eVih m,nt'hc p' / e.✓ii f""l��l ndhani Ete Plan including location <br /> 1;7? C,►'rckJ - 1 33 tut le. brook rr. A O DDR s}hh/e ofwacks tic <br /> State, I+-C`y , � <br /> ��►zp ,/� ; 73.5,_11(c. s/rate,Zi , L►�Setbacks <br /> 'PHO E 11^G I I �) la P�W'� C' ,,/ II I mah G <br /> vg. 2117_ fi g— 10 7 ('7r� _ q/; J��✓�Q ❑Site Plan royal from "� <br /> U �1 i-mi E AIL S 7 �� ��� /'1y� aPPli etownship. t� <br /> I '[ c � � ' -,AIL ADDRESS /� / .p <br /> f^� �� V ► I / �� A. a / I r u l7/ Q�(f j or plans to scale t <br /> t PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ❑PARCEL PARCEL NUMBER: NT ZONING: ACREAGE: levatlon of property <br /> Q,,j�,r NUMBER 0 i - 1. oI) f c.114 * 1� frontage drawn to scale. / <br /> TOW IP: <br /> > SECTIO <br /> 0� U Y K� a � '/.: $��'0 %14: /v � �riveway permits � <br /> AmS?c� u rc �, (state,county,town) / <br /> CSM: LOT BDIVISION BL. K./LOT/LOT ry permits Jo 3 <br /> Sandi <br /> i 3 ' e , <br /> r j (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DeCRIPTION: STAFF REVIEW <br /> Ji h e, i!f Q hri t / -a � r lit 'C II Wing District <br /> • $This project s' new building or strYcture. <br /> ❑This project is an addition/alteration to an existing building or structure. emitted Use? <br /> SANITARY SERVICE: PERMIT ❑ a_ <br /> EWER I�pEPTIC ._(� u J I _ _ (�ng) \ <br /> HEIGHT IN FEET: i V NUMBER OFffirORIES: (Not including basement) //1 `O <br /> ❑ Wetland/F lain/ 0 V r <br /> AREA TO NEAREST SQUARE FOOT: Sh0 d (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ Eropes,dintrtslpemit �0 e <br /> 4 TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR:'— 3RD FLOOR: <br /> ing/access) <br /> O.0 Survey <br /> ESTIMATED CONSTRUCTION COST: $ /� /-t91 (�• a available options. Ye S <br /> (Please round to nearest dollar) ♦ ♦ '► ♦ $ 9\(2.0 <br /> / ..- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es Atik 2. Is there a wetland or floodplain on or near the property? ❑Don't know <br /> Oyes ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? �S'es No <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# <br /> (leave blank if none) <br /> 6. Is a location survey required? (see ,rtires ONo ['Don't know <br /> 7. Is this to correct a violation? <br /> Elves <br /> " <br /> APPLICATION MUST BE SIGNED <br /> 545-112(8/09) (Continue On Back) -� –� <br />