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Ire ,,, c <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Wets App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> :Times- An- <br /> ____ <br /> OWNER ADDRESS (Number,Street,City,State.ZP) ❑ Zoning Stat UP; <br /> ,"%la Cr', 1/1-1V % r�/ue n ,r j/j a.�c' spi77 Deed R n;CSM <br /> HOME PHONE CELL PHONE ri (# ) <br /> /ror .774vZ1 idY 774.11 E-MAIL E aw`�SS <br /> AGENT INFORMATION ❑ Site Plan drawn to scale N 6� <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ej( GC fi <br /> AGENT ADDRESS Li Site Plan including location <br /> QCONTRACTOR ADDRESS of well/septic j'�) 0 <br /> (City,State.ZIP) ' <br /> - r <br /> (City,State,Zip) Li Setbacks l Q ,,b v t R c/ <br /> PHONE PHONE ❑ Site Plan approval from <br /> pplicte township- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> f <br /> diFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdanP.co.dane.wi.us.i) <br /> PARENT PARCEL NUMBER: CURRENTZON,• • I ACREAGE: Elevation of property <br /> ❑ PARCEL , !D Cld GY/038$Zp0 7PN3 `� frontage drawn to scale. <br /> /1447 <br /> TOWNSHIP: SECTION: - <br /> 3/ar /1404001S /a '/<: Sccj '%%: Ajbj Li Drivew permits <br /> ADDRESS: (s ,county,town) <br /> !t?LSd CTV>/wy T!7 e/me/llirt eis tuft 5'?S71 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ San' permSUBDIVISION I1275"' Go' Z (p lic,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: _ -STAFFREVIEttY .. <br /> � a�hL� Dc a0 ,cry <br /> ing District <br /> • ❑This project is a new building or structure. emoted use7 <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ Rural 'ri 1 : <br /> D SEWER al SEPTIC (new -xistin.) <br /> HEIGHT IN FEET: A NUMBER OF ST S: (Not including basement) <br /> CD Q Wetian <br /> AREA TO NEAREST SQUARE FOOT: Shor {� t) <br /> (Outside dimensions including unfinished area,attached arages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Q?�� ❑ Erosion + + . permit <br /> 4,TOTAL SQUARE FOOTAGE: (slopes 4 isturbance, <br /> 2ND FLOOR: 3RD FLOOR: r30 fitIi i .Ccess .. <br /> ESTIMATED CONSTRUCTION COST �V Review Location Survey <br /> (Please round to nearest dollar) -► "► -4 -► - - -► $ h p 0© .available options" <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Ig Yes ( o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑yips [. o L.1 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? a s ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LYYes ❑No <br /> 5. Is this project associated with a rezone/CUP/varance(petition/appeal# ) (leave blank' one) <br /> 6. Is a location survey required? (see re\(erse) ,❑ es C o CI Don't know <br /> 7. Is this to correct a violation? Yes '1,*. <br /> APPLICATION MUST BE SIGNED <br /> 545-112(ams) (Continue on Back) -o- -4 -► <br />