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3 6538 <br /> ZONING PERMIT APPLICATION www.countyofdane.com cSUPPLEME1Tto_Web-Appl <br /> • <br /> PROPERTY OWNER INFORMATION '. CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> NE`ar IC(`eJ v G.r b:,k/{ <br /> i r I Zoning Status; CUP; <br /> OWNER ADD%ESS (Nuo r- C City,State,Z ac,� 5 <br /> �-„`f/ �fj�C_) `/)f_� J 1 � �3� Deed Restriction; CSM <br /> c,t� � Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Mpg Lit�c/ 3og3 4:41-7/4-47s-7 ba_jCken fctrn-7 Ec 5,mc .,cdi''1 n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INMIVIATIONr r, and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I I Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE I I Site Plan approval from <br /> applicable township. <br /> E-MAIL AD DRESS E-MAIL ADDRESS <br /> I Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co,dane wi us/) I Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> l l NUMBER Cileel/ , � <br /> /-�1c)- 1 /(Ex ) 13 cy frontage drawn to scale. <br /> TOWNSHIP: L SECTII66N: <br /> .P cJc.v-1. . Sprc'v 1 g 1/4: 1/4/4: [—I Driveway permits <br /> ADDRESS: r d�� ( LL`� (state, county,town) <br /> RECI 1 0O°' C►�.G Cam ' cS-f --i1:1-°r n Sanitary permits M <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATIONA.a:,;STAFF REV.IEIN <br /> PROJECT DESCRIPTION: 4 ( !1 �adjT a 3`� 2 F <br /> b tai►� loo le bar l\ lei s fl n gzDjs nco f <br /> This project is a new building or structure. °ermitm Uses ,� <br /> This project is an addition/alteration to an existing building or structure. '''''..0i,-,"�: ` t <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> g LIa.R raj Add e '` - .: <br /> f SEWER EPTIC <br /> new exfstmg}v; �`' <br /> HEIGH/T�N FEET NUMBER OF STORIES: (Not including basement) 14."s '° -. <br /> 1 `4 i 1Net(an�ood°1a <br /> Shor�e1and ‘&..1.!,'•,' <br /> hrnent , ', <br /> AREA TO NEAREST SQUARE FOOT: -?: = ,-,u <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) x - <br /> ® i-osionContro:perra�t` r <br /> BASEMENT: 4 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: (s op s istur anC ,�. <br /> L� -fiWn-glaccess =u - : <br /> 2ND FLOOR: 3RD FLOOR: I,3Q 0 Q7_, � x <br /> � Revte oca on..Surve <br /> ESTIMATED CONSTRUCTION COST: // C =anyne-1 a.onS e - <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ -► ♦ 7 Q "" -/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wel Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 42 Yes No n Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes`� Ili o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? •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) 7 Yes .No 7 Don't know <br /> 7. Is this to correcta violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► --■' <br /> 545-112(4/08) <br />