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t <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA �/ �/ /� 2 <br /> 4 to ✓ -7 /f#/ t' g <br /> Zonin Status; CUP; if <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> /00 6. #11/Y 7 S t` -hi r�6 6-'5-7'- Deed Variance Restriction; CSM <br /> h Variance # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4 cis-437 C- - c 4ob-4yL1— 1E/7 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME , <br /> 6 Roy ghl y7V eft L, r J7 f(. h Si-r(C//Witt, a21 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> / o5— //wq -7 T /0404 435^7 Si(4/7,`z- /p p Z <br /> (City,State,Zip) (City,State,Zip) 'Setbacks / �� �0 <br /> op° <br /> PHONE PHONE Site Plan approval rom- / <br /> Gee_ C/y y /C*7 5/�-,�.h applicable township. �A <br /> It- <br /> E-MAIL ADDRESS E-MAILADDRESS ppp��� <br /> %Floor plans to scale / <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) / t <br /> PARENT PARCEL NUMBER: q CURRENT ZONING: ACREAGE: MElevation of property <br /> ❑ NUMBER ,e/to0� '-37/.^Off/�a-a /'�"" L. a 3/ C frontage drawn to scale. / ? <br /> TOWNSHIP: i'"` SECTION: <br /> 66/14e- o undo 027 1/a: At 1,41/x: 510 A i . -wayper .- <br /> ADDRESS: 4,County, own <br /> CSM: LOT SUBDIVISION BLOCK/LOT/ Sanitary permits /T <br /> (public,private) /'' <br /> 19-0 3 <br /> PROPOSED PROJECT INFORMATION 'ST,AFF REVIEW <br /> PROJECT DESCRIPTION: f� D A <br /> /vat/ gi U e w -I- 1 o /e S41 €O7 02 X/70, o,� Zoning District! <br /> P building Permitted Use? '' t ' ' <br /> This project is a new buildin or structu - , <br /> ❑This project is an addition/alteration to an existing o• i•-. • - <br /> SANITARY SERVICE: PERMIT NUMBER: r .R I Ac dress <br /> xisting)' <br /> ❑SEWER ❑SEPTIC +,? 4 ' <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) �, ' <br /> P'•s i odp(a�tf <br /> ore . (attacf 4.ifit ti <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> air rosl nP-c if el'•er, <br /> BASEMENT: 1ST FLOOR ' <br /> . 4, TOTAL SQUARE FOOTAGE: j (siopi0i y1TA. Ili k <br /> fillingfaccess) <br /> 2ND FLOOR: 3RD FLOOR: 30 l <br /> 7 Revfewocat -Rxiry . <br /> ESTIMATED CONSTRUCTION COS7` $ �Z 0 0 0 i (�daWS[Iabr o ttit <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ G lI tJ ,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ci0 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ViYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? p Yes ❑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 51-No ❑Don't know <br /> 7. Is this to correct a violation? • -s ca No <br /> 'f' . 72 AP- (CATION MUST BE SIGNED <br /> 'ontinue on Back) —► —► —■ <br /> 545-112(4/08) <br />