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(4) .-7. e? <br /> ZONING PERMIT APPLICATION www.countyofdane.conl =SUPPLEMENT,to_WebApp.#_ <br /> FROPERTY OWNER INFORMATION - CUSTOMER TO PROVIDE <br /> OWNER NAME q l , <br /> e_0(1/1 ,L /V%r n Zoning Status;CUP; <br /> OWNER ADD SS (Number,Street,qty,State,Zip) Deed Restriction; CSM <br /> 7/ � S/ 4/ ,C� �'r `-.l `r S,?5'-3 Y Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AI3DRESS <br /> y✓•^� l�b),IO�-�?61 n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR'INFORMATION= and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> n Site Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRESS of well/septic <br /> (City,State,Zip) (City,Stat ,Zip) n Setbacks <br /> PHONE PHONE n Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL Ai DRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION .(http p//accessdane.co.dane.wi:us/) _ :❑ Elevation of property <br /> PARENT PARCEL NUMBER: CUR NT ZONING: ACREAGE: <br /> ❑ NUMBER d slit---3 yl 7.3 791- i /, (f7 frontage drawn to scale. <br /> TOWNS IP: SECTION <br /> /6i 0' 4 ,�4: ,/4,/: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> n Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REWIEIN ' <br /> PROJECT DD�ESSCRIPTIONN: (( ,try . , <br /> /14 YPv G.4 Fon `2oJ % 14 O is r)Ct ..- ; <br /> . This project is anew building or structure. -p 7' "' <br /> ermttt-_m Use_ <br /> ❑This project is an addition/alteration to an existing building or structure. ixij=� " 4 5 - ,. <br /> SANITARY SERVICE: PERMIT N.UMBER: a3 AddressAZ� 0 <br /> nSEWER nSEPTIC ; newiexistin6 ? 47` <br /> C- ..,l t Sit,, <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ,. ? �k'"4' h- �=' <br /> 1Et�ail 30Dd a6 ' <br /> Shore aril attachment) <br /> AREA TO NEAREST SQUARE FOOT a; ..,1 ,�+. <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <_„ �' <br /> BASEMENT 1ST FLO R: > <br /> ',E1 547131 <br /> 4, TOTAL SQUARE FOOTAGE: ,j, f S Ope ;:Lj1StUFba C� - <br /> filltrtg/afi,CeSS) = <br /> 2ND FLOOR: 3RD FLOOR: � . <br /> Li i8 "xOCa[OR� � <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► --► --► f F and4�railat e opfion � <br /> (Please round to nearest dollar) �w g . -,� <br /> 1. The property is within 300 feet of a stream or 10001 feet from a pond or lake? ['Yes 171No 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the prop;lerty? ❑Yes Ef No n Don't know <br /> 3. Have you talked with the township about your prof ct and are they in agreement'? 0Yes ❑No <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? ❑Yes M No <br /> 5. Is this project associated with a rezone/CUP/varia ce (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ©No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes R1 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i .9 -4 <br /> 545-112(4/08) <br />