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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME <br /> 4 eve A /5 <br /> OWNER ADD�SS (Number,Street�ity,st ip) �^ De- . estrus; Cu; <br /> `/7f (� r"'1 De-. Restriction; CSM <br /> �� e ` Ci �3SL,y Va,ance(# ) <br /> H ME PHONE CELL PHONE E-MAIL ADDRESS ��G� <br /> (( ).?3) 6 06,9� ---- 5 ' ` / 6'� - i,/ , _. •M :Ite Plan draAnT <br /> AGENT INFORMATION CONTRACTOR INFORMATION . d includesldiin sWs <br /> AGENT NAME CONTRACTOR NAME <br /> -,5B'L7 4 (o w 2 ff Al L`ii P5 ,v s J Site Plan inclu g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS «<, of well/septic/ <br /> 72 7a c , II"- y A ft <br /> (City,State,Zip) - D ( (City,State,Zip) El Setbacks <br /> r i T 6Gfz fib/ 3-3":7 i <br /> PHONE / PHONE ❑Sit P an Ova�,f _ <br /> (G o$) a }Q - 6 37/ -- a pf a towns i / <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .— zips, q/Yr R^ ,-4-1S e#S,c,„,,,...1 I or plans to s e <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) lev •on of ro erty/ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P �l <br /> EPARC ©7cS'-3o/_1,26'8-. — / , �,j- fron gedraw sale. <br /> NUMBER <br /> TOWNSHIP: / SECTION: <br /> / <br /> 3o 1/o: 5't 1/41/4: ,/� ❑ Dr e y perm*, <br /> ADDRESS: ( county, ) <br /> �e r1c e )_3 <br /> S. itary permits <br /> CSM: LOT / SUBDIVISION /�1� BLOCK/LOT <br /> 8 (• bli , prl/a $) <br /> I PROPOSED PROJECT INFORMATION S AFF REVIEW <br /> PROJECT DESCRIPTION: U <br /> 1g...,, 5 i I Z. ing Distritr" <br /> • This project is a new building or structure. ❑ Permitted L ? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: • 'lira! Address <br /> FIEWER ,:PTIC 1 3—...)-p/5-- op3 6 3 (ne existing) <br /> HEIGHT IN FEET: ,-----,----- NUMBER OF STORIES:STORIES: (Not including basement) Wetland/FI plf}/•ad?' Shore! (atta(chhnent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErosionCo OI permit <br /> BASEMENT: 1ST FLOOR: c� <br /> /j-CF8 "2 89,6 4, TOTAL SQUARE FOOTAGE: , (slopes Isturbance, <br /> fillip ccess) <br /> 2ND FLOOR: 3RD FLOOR: ()3 g8�a _ ❑ Review Location Sur y <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ ♦ ♦ Q� and available options. <br /> (Please round to nearest dollar) $ `f,�'of 1,/:, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [ Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ii''es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des 7No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• none) <br /> 6. Is a location survey required? (see reverse) s No nDon't know <br /> 7. Is this to correct a violation? ❑Peso <br /> $Li s) '` APPLICATION MUST BE SIGNED <br /> te <br /> sas 11z(aioa> <br /> (Continue on Back) ♦ ♦ -♦ <br />