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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# _ <br /> PROPERTY.OWNER::INFORMATION = , • . ;,, r , <br /> OWNER NAME ., :. CUSTOMER TO PR VIDE <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning StatUS;CU ; <br /> 2-093 US H w y )2_4- $ Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE G CELL PHONE E-MAIL ADDRESS ) <br /> 60a-873-43g' <br /> WSite Plan drawn to scale d' 26 d <br /> AGENT INFORMATION ;.:; ' CONTRACTOR INFORMATION.; ,_ and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C-#t2lS rn VI-1- — Ca�S-r L L.i ( & R L5 M l LJ- & Go,�.S 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS LLC, of well/septic <br /> (City,State,Zip) 53.�z7 (City,State,Zip) Setbacks 3 /5/50 <br /> �rr-A c 6 c2c .r- w 17 <br /> PHONE PHONE • #'1 Site Plan approval from <br /> (.04)8- 2 1 Z— 1.3 ce co applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> AI 'Floor plans to scale <br /> / <br /> PROPERTY/LOCATION INFORMATION .(http://acce.ssdane.co.dane.wi.usi) ., , s <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: '��i Elevation of property 1 <br /> ❑ PARCEL <br /> NUMBER O 19/0-7►I- 35 3-9.5.2.5 I A-1. GI, 40. 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Cv'IS AC�i✓ C�RavE 3 5 I/: 5. J IA'4: 5 E Driveway per <br /> ADDRESS: (state,court 01N <br /> �'d Sanitary• �.:•� <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> j (public, <br /> PROPOSED PROJECT INFORMATION, ' , <br /> PROJECT DESCRIPTION: n <br /> SF' ¢ . <br /> . % : <br /> • XI This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. rz x fr t t '' ; <br /> SANITARY SERVICE: PERMITNUMBER: c '. Fr - �� <br /> ❑SEWER SEPTIC • � � / <br /> HEIGHT IN FEET: 6/ NUMBER OF STORIES: (Not including basement) £ W dJ <br /> .. I• �," 1� 7 ��� CW =- <br /> AREA TO NEAREST SQUARE FOOT: -- t- �:--:,-,. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)BASE MENT: 1ST FLOOR: lO Z, 1t7 � r � � <br /> I 7 3 /_ 1_1 3�` , 1 Tsw�n 4, TOTAL SQUARE FOOTAGE: I, _V�„l�1- '�t t "- 0 2 3g <br /> 2ND FLOOR: 3RD FLOOR: r <br /> ESTIMATED CONSTRUCTION COST: t <br /> (Please round to nearest dollar) l , I ocro ,"? _ , : z , <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 3allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ]$Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Alo <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 XNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1,tlo <br /> -- APPLICATION MUST BE SIGNED <br /> 545.112(4/08) 1 p (Continue on Back) -► -o. -∎ <br />