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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �"P SFKi ®Zoning Status; CUP; <br /> WNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> i t\(o o !Z,,I�M P.amt.r t �� • ' r c utr►rToN 1 Ni i S.1 V I Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> r <br /> n`b 1.3 S-Sys - �s tan .' ,_F 1^ to Imo.C 6 M Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> \A� ELCI..E JF }a diL( =(L! (s2oop 1N �i ©Site PI • cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS I of s tic <br /> tdQ. S. SwFt L. IQ a, S • ov\iFli ZCt <br /> Aity,State,Zip) (City,State,Zip) ©Setbacks <br /> NC)isot. VN\ 'ST 5 MAD Oaf" v4 3�0S <br /> PHONE PHONE I]Site P -n a.-- .val from <br /> 0°)#9.0°1 - 0011 �p 0`2) O'ioc T1 alp. • -. e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS OeC S� <br /> CG FS. III _ ILO ' G(LcDv• •cc �, L 1 ,� .G.ea •. co <br /> [ ] Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL PARCEL NUMBER: CURRENjONG: G/� ACREAG <br /> �t IS—( o frontage drawn to scale. <br /> NUMBER cJ otn 1 2S 3-BBSb t� <br /> TOWNSHIP: SECTION: <br /> '/4: '/4'/a; g Driveway perm' <br /> TOwN of Dv N N (state,coun ,,town <br /> ADDRESS: ( town) <br /> rttDi H N PT. 17t4- S'Z.WQ-1-(,atJ vii 5513c1 Zi <br /> CSM: LOT SUBDIVISION BLOCK/LOT S- permits <br /> O1a3 public, ,:vete) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �� <br /> �// Cng District <br /> . MThis project is a new building or structure. nrmitted Use? <br /> This project is an addition/alteration to an existing building or structure. `��` <br /> SANITARY SERVICE: PERMIT NUMBER: oral Address <br /> EWER FIEPTIC xisting) <br /> HEIGH N FEE N NUMBER OF STORIES: (Not including basement)ki,, �S 73' eNC c <br /> Li Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOO <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> •sionControl permit 1ST., .. <br /> L �., <br /> I G Zs I (\\ + TOTAL SQUARE FOOTAGE: ,, ,sl••eS,disturbance, <br /> ZS fit' • access) c <br /> 2ND FLOOR: 3RD FLOOR: <br /> n <br /> ESTIMATED CONSTRUCTION COST: CJ / ill Review Location Survey �/( <br /> (Please round to nearest dollar) -♦ ♦ ♦ ♦ "0. $ �3 O k and available option <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ®Yes ❑No ❑Don't og.-7 Is there a wetland or floodplain on or near the property? [Yes ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? I Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes M to <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 ENo EDon't know <br /> 7. Is this to correct a violation? Des MIN <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -+ - -► <br />