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ZONING PERMIT APPLICATION .countyofdane.coCll SUPPLEMENT oWeb•App <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER RNNAM ,!� (� <br /> ."5`-I b �0� /llu I Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,Cit�,State,Zip) <br /> 2S r 3T n 44� 6 )2_, l 5 3 27 Deed Restriction; CSM <br /> HOME PHONE CELL PHONE (� " r 'E-MAILADDRSS 1 Variance(# ) <br /> ,t '-g1 -.1212_ , 22o •2-u}'7L- e((G •roc\I c v ne± n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION <br /> -�; and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> ❑ 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-MAIL ADDRESS E-MAIL•6DRESS <br /> . ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/),1,- <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER •W1 -(II - g7ol -D 1, t � frontage drawn to scale. <br /> TOWNSHIP: SECTION <br /> -PL � 1 I ,/4. /4,/: ❑ Driveway permits <br /> ADDRESS: ,,,, ''G,' /,�,-r-r-�l _ <br /> (state,county,town) <br /> 2 3o � & 5T � ' ` A6 ^e, WI 53521 ❑ Sanitary permits <br /> CSM: LOT SUBDIVI ON BLOCK/LOT <br /> 103 I ) 3 (public,private) <br /> PROPOSED PROJECT INFORMATION . TAFF•REVIEW ',` <br /> PROJ CT DESCRIP t"Z _ . .r <br /> onrng Bs 1 r '" k <br /> • r This protect is a new building or structure. +� A YV, <br /> i_i LI This project is an addition/alteration to an existin.. building or structure. - " -=5 6 ," <br /> SANITARY SERVICE: PERMIT N' MBER: o s` <br /> � = x��a yam,s�.�_' <br /> SEWER SEPTIC <br /> HEIGHT IN I NUMBER•FiSTORIES: (Not including basement) '" � � <br /> a etaT]emopooa` <br /> bore 1?,a r <br /> AREA TO NEAREST SQUA"E FOOT: ,,, < <br /> (Outside dimensions including unfinished area,attached ga ages and above grade decks or porches) ' . #� - .;.-,. <br /> BASEMENT: 1ST FLOOR: "� � ® C mA O oef�31 r <br /> 4, TOTAL SQUARE FOOTAGE: 4, is9 1s oa_L1G <br /> 2ND FLOOR: 3RD FLOOR: fi � .. � '' '4 <br /> 'S <br /> l J <br /> r3 N� . <br /> ESTIMATED CONSTRUCTION COST: � ��J <br /> ac <br /> (Please round to nearest dollar) ♦ –I. ♦ ♦ 550 V / <br /> ,,, ,, =z- y- v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes 8 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the prop-rty? ❑Yes ONo ❑Don't know <br /> 3. Have you talked with the township about your proj-ct and are they in agreement'? 4Yes ❑No ' <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes R1No <br /> 5. Is this project associated with a rezone/CUP/varian e(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes fl No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -9- -■ -♦ <br /> 545-112(4/08) <br />