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IGLI- <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ` f <br /> �J e-f ✓"•e VC+ 1--ALIvON'-\ 6 '-)CC-1N ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> G 7 V e r�o ,,,r`c variance(# ) <br /> HOME PHONE CELL PHONE 4.MAIL ADDRESS <br /> 104 719.2_24s c9,17 77-71 rAepv,zi /3-0L ° Cc, ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A9F,INT NAME I CONTRACTOR NAME <br /> re f ter r /i`A ❑ Site Plan including location <br /> AGENT ADD`�S \ CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Curs tames [Air 5-35zi? <br /> NE PHONE CI Site Plan approval from <br /> PH 6'Q 8 .7Qg2Z,6 g applicable township. <br /> E- ILADDRESS E-MAILADDRESS <br /> Ahe V 0.e4 / I)y A COY-v.. Li Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING( ACREAGE: ❑ Elevation of property <br /> frontage drawn to scale. <br /> ❑ PARCEL A^ i .e g <br /> NUMBER O 7 0 6- 114'9 CS5- �( /�3y ci <br /> TOWNSHIP: SECTION: <br /> V Qr c r� 1/4' 1/41/4'S 1 ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: Y,G,z,--t l,f t I &c) <br /> CSM: LOT SUBDIVISION BLOCK/LOT CI Sanitary permits <br /> l� R (public,private) <br /> PROPOSED PROJECT INFORMATION '"STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> L.Zoning District <br /> . 10-This project is a new building or structure. ❑,Permitte'd Use'? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: i,a,R'digiA&Ii;esiUJ <br /> ❑SEWER (�SEPTIC (f)ew/existing) c t <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ,,: <br /> � /�, T Q Wetland/Floodplaln/ <br /> �'1 l Sfiorelandattchment <br /> ARE TO NEAREST SQUARE FOOT: e <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR:0(6172 ❑ Ef Y,,,ti Cont1`> .9 G'r17T1 i <br /> �� 4, TOTAL SQUARE FOOTAGE: j (Slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 38 3 flfllCtg/a tress)I <br /> ❑ ,Review Location Survey <br /> ESTIMATED CONSTRUCTION COST �� and availal7le�oons <br /> (Please round to nearest dollar) ♦ ♦ '♦ ♦ ♦ ♦ t ..,. . ,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes in No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes El No Li 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? Li 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) Li Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -p -p <br /> 545-112(4/08) <br />