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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-AFp # <br /> . <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME // <br /> PA1 <br /> D D L <br /> U9AS .- I .°// Zoning Status;CUP; —4 WNER A RESS (Number,Street,City,State,Zi ) <br /> II eed :- .•I• CSM <br /> .6-g 7 ha.-4•2 -IV/l/-e R gre:› 14Tout Gv; S3S1i <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /i7--'373—?,2111 C8-?`ib' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION : i I c LI- e-Fr."Thigia,,I <br /> AGENT NAME CONTRACTOR NAME ■ <br /> T-M if4.4-T in ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ -• '.:�i■■. / <br /> l,3 c 1 P/"-e-lv er ST ? V �/ <br /> (City,State,Zip) (City,State,Zip) ❑ Set•ack- 6> ;0 �d <br /> ..,-„G5 Gr70h Gvi 0 <br /> PHONE PHONE �3� jSite Plan .sproval rom. / <br /> f—g.73—57 79 applicable township. /�/l4— <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> !�•/ <br /> J=O Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) P-/ Elevation of property <br /> PARENT P EL U B CURR TZON ACREAGE: <br /> ❑ PARCEL u5i7 S.Spd 3 �-y 3/. frontage drawn to scale. <br /> NUMB R <br /> TOWNSHI . f/ SE Q:17-10 • � <br /> (,. r. )� 1/4: �'� '/4'/4: C/� :ffDriveway permits kik- <br /> ADDRESS: (state,coup 'own <br /> �g 2 & In v. a y- v.' It f.._ A J0� <br /> ,,2 Sanitary pe:;;ts / , w <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, i <br /> PROPOSED PROJECT INFORMATION .:$TAFEVIE i °\ <br /> PROJECT DESCRIPTION: `f <br /> 6 QGk ell Zoning <br /> ®Istria <br /> . ❑This project is a new building or structure. Permitted UseT '° ` <br /> This project is an addition/alteration to an existing building or structure. � �' <br /> SANITARY SERVICE: PERMIT NUMBER: R€rral ' ° <br /> (ne XIS In• <br /> ❑SEWER ,SEPTIC ,f! <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �� <br /> T� �tfet ,,,,,loQ ipiow,,.,...„ <br /> Shore and (att`achmena. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) g 5' r <br /> � EroslonCca��o�perm�� <br /> BASEMENT: 1ST FLOOR: 2 9 ,` Ince <br /> 4, TOTAL SQUARE FOOTAGE: (Slopes,disti.0 <br /> 2ND FLOOR: 3RD FLOOR: 3- 1p1oI <br /> i, <br /> ❑ Revlew Locati*,8 0:6 ' <br /> ESTIMATED CONSTRUCTION COST: $ / Z ` and avallabie c�ptlons <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ / ®DD <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ANo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? p,Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ANo <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 74 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes �_4 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />