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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App It <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> A <br /> t-N �0 c`c g n Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) - Deed Restriction; CSM <br /> Os oS i ti c v..P+1-I S I MD' - +-v l &---3 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGGEJT NAME CONTRACTOR NAME / <br /> K EI�) A]�A NHS rt-�7A-sA s Des, a l./ c o -re t n Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Po `7 7..1-7 PD 6 - -77 7 <br /> (City,State,Zip) (City,State,Zip) _ ❑ Setbacks <br /> NA A-3)1 SerL. 4.)1 c3 7 a 7 <br /> PHONE PHONE ❑ Site Plan approval from <br /> Mo&ILE ( Ob' - 413g. SS-03 60& - `l ) - 9 oz' applicable township. <br /> E-MAIL ADDRESS I E-MAIL ADDRESS <br /> K.SN C cxd a•...,.s v-c,,,,,LS,o.L _ c..r-. ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http eUaccessdane.co.dane.Wi.us/) , . ❑ Elevation of property <br /> PARENT PARCEL NU BER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER 4 o 8 16 7io - os 1 - 9 801 -3 '- [ 09 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> DM sZt re-00.1"12- 1/: 1441A: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVIEION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION `'ST Ca REVI `4) <br /> PROJECT DESCRIPTION: ' `' t <br /> vl ,S F (ao e D t T O nl I V 6 0! ; �onmg 1) s aw ,,_ w <br /> . ❑This project is a new building or structure ,7:4441';` <br /> aThis project is an addition/alteration to an existing building or structure. w ; -, <br /> SANITARY SERVICE: PERMIT NUMBER: ra 'tr. S -A- <br /> SEWER SEPTIC � "�� <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) -S V ''' ±2' <br /> C2 0 Ir T ettan e` od® � z <br /> 4 a o .z P-ctlrr entj <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) OSO f; P oe -I if e <br /> BASEMENT: 1ST FLOOR: T -`0 d <br /> . TOTAL SQUARE FOOTAGE: j, o o e 01S r a anc ;,� <br /> - <br /> 2ND FLOOR: 3RD FLOOR: ::..4 p e a ��. .-- . <br /> Ig 10-4 '"'--.-S-11-7-_.,;,-�a <br /> o iio5e <br /> ESTIMATED CONSTRUCTION COST: �-lc� o o <br /> - :e e <br /> ` <br /> (Please round to nearest dollar) --► -11. —10. -► $ I D o ; .; �g= 2,/ <br /> 1. The property is within 300 feet of a stream or 1 009 feet from a pond or lake? ❑Yes YINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro rty? ❑Yes 611No ❑Don't know <br /> 3. Have you talked with the township about your proj ct and are they in agreement'? Yes . El No " <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? EYes g No <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (le ve blank if none) <br /> 6. Is a location survey required? (see reverse) IYes 0 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes rg No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ --► —► <br /> 545-112(4/08) <br />