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ZONING PERMIT APPLICATION www.countyofdane.com3UPPCEMNT"to;_Web=App_; , <br /> . : � �:PROPERTY OWNER INFORMATION -.. =-F- - .l.� • <br /> CUSTOMER TO PROVID <br /> OWNER NNER NAME ,/� ,/� /� <br /> K./ I W /J � 4 S 0 Zoning Status; CUP; ` '" <br /> OWNS ADDRESS (Number,Street,City,State,Zip) ' / Deed Restriction; CSM ?...S 2) <br /> & 3 (D 0 S(4NSE y- ,d2 1 v E V1'0/`e x-359 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,ii Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR IN¢OR1111ATION and includes dimensions . <br /> AGENT NAME CONTRACTOR NAME <br /> ( ' X MZcf Q wG t,,; GkAft41Tv 1/`)E-5T CPAIJ 7 g Site P , ing location 7QC' <br /> . AGENT ADDRESS CONTRACTOR ADDRESS of ell/se f e. L 3�3© zs� <br /> (! state zip) / Z (City,state,z x / Setbacks / <br /> 04 t I/0/-,v- ; w/ 'J 7 Z- /7/0 ( w) SY S-72 . <br /> PHONE PHONE Site Plan approval from ,,/ <br /> (v p (6 _ 7 9q, 7 7 V t, i) `, — —2? _ ? 7 75/ applicable township. /, <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> c (AG4ii y t,,JeS6-inc 09)-04j/ .--a ✓'' uct/it y west 'A n ck.- <<i,l , Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.danewiusl) <br /> 1 k Elevation property <br /> PARENT PARC NUMBER: CURRENT ZONING: ACREAGE: <br /> �� evaon o P P ert Y <br /> n PARCEL 1�c1 3— C� frontage drawn to scale. <br /> 1 t NUMBER ()U.? becA7- faii- t'�,2 1 I - 0 — / <br /> TOWNSHIP: SECTION: <br /> UW "QH4 Foo-p 2(0 <br /> .1/4:5 L------ 1/41/4: Nr_ Et Driveway permit <br /> ADDRESS: (state, county town <br /> (523ceo SU NSF,— )2)✓� <br /> ,vSanitary <br /> csM: ? Cl LOT Z SUBDIVISION BLOCIVLOT (public, rivate�% <br /> PROPOSED PROJECT INFORMATION zj STAFF REVIE1N.- 'f-," <br /> PROJECJ D1CRI N: , / �/ / s 3 ? � , ¢y <br /> ill / Li ^ / 2 O4 re Mc_rx 4 clip, 7�e -4 0- nmgols tie z: <br /> n This project is a new building or structure. s r�� ,t3„per 1 `o'lJs - <br /> Ix This project is an addition/alteration to an existing building or structure. 1 , is 0, `';� <br /> SANITARY SERVICE: PERMIT NUMBER: �a1;,R rai v S <br /> nsEWER SEPTIC r,, raew xist111g t-`�: , <br /> HEIGHT IN FEET r NUMBER OF STORIES: (Not including basement) ` r° <br /> I Z / Es'1Netlant400d a s. <br /> - - oreTand4ttachment) -;x <br /> AREA TO NEAREST SQUARE FOOT: f <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ` t" ` <br /> BASEMENT 1ST FLOOR: • 174 .ETOS1onContro perin#1 <br /> /71 4 TOTAL SQUARE FOOTAGE: 4 S ope istar6_aanc , <br /> fitting/access) : / 1 <br /> 2ND FLOOR: 3RD FLOOR: 6:-_7yc s lei r s" f <br /> 1€3 Reyie lcica ion riry- - <br /> ESTIMATED CONSTRUCTION COST: O C� t , ancr yailab eapphon ;� ,. <br /> Please round to nearest dollar ♦ '♦ ♦ ♦ --I- ♦ $ 3 b c) 'c � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes [71 No Ej Don't know <br /> 2. Is there a wetland or floodplain on or near the property? n Yes m No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? E Yes n No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? El Yes 1151 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) fYes J No ❑Don't know <br /> 7. Is this to correct a violation? ''''"•••■■. . DYes ; No <br /> J 6. y, 2 APPLICATION MUST BE SIGNED <br /> /// ,"(Continue on Back) ♦ -► -► <br /> 545-112(4/08) <br />