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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW ER NAM/ � �� <br /> • NAM(E... Zoning Status;CUP; <br /> eNERADDRESS (Num r,SJtr(et,City, ate,Zip) Deed Restriction; CSM <br /> g i 76 3 50Z Variance(# ) <br /> HOME PHONE CEL PHONE E-MAILADDRESS <br /> oZ.7 2-0 7 < �_ Site Plan drawn t s le <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dim ions <br /> AGENT NAM Q ! CONTRACTOR NAME //�� <br /> U(/G� z L G/>%Q_r' ,C4('(1G��.a 1 1�1 C 'ite Plal j'�cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS, of well/sW ti <br /> 33/T. w.S r p <br /> (City,State,Zip) (City,State,Zip 7. tbac <br /> PHONE PHONE Site Plan appr v ITV.••C F50-1(C-5' applicable to h <br /> FS0- <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS <br /> door plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P <br /> PARCEL 010E-0 59-OG7L /1 j n ' frontage draw t scale. <br /> uu NUMBER 7 O'V I< f� <br /> TOW SH P: SECTION: <br /> 2/Driveway/�fv...n 1/4: 1/a1/: L�J uriveway perm'+. lief <br /> ADDRESS:ADDRESS: , ! ^ n � (state,count town <br /> /F,/ �✓� / ��l9 [�S nitary .e 111,) ` <br /> CSM: LOT SUBDIVISION JOCK/LOT <br /> P- , (pubr ,private" <br /> 9 <br /> PROPOSED PROJECT INFORMATION �; <br /> PROJECT D,ES TI9 i %�%',14.7.7r....tt';;' otrle:7,e,,,.,,. :: <br /> N / , <br /> his project is a new building or structure. <br /> El This project is an addition/alteration to an existing building or structure. 4 <br /> yam' ' <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> SEWER EPTIC V'''.!1 { <br /> HEIGHT IN FEET?, NUMBER OF STORIES: (Not including basement) /, <br /> Ot9 ,1441, ,,Ell 4 ,K. ,� , <br /> AREA TO NEAREST SQUARE FOOT: ' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) F <br /> BASEMENT: 1ST FLOOR: O�y �. ° ° <br /> /a) f 11 ,, TOTAL SQUARE FOOTAGE: + t• , <br /> �q i SiR mss,. <br /> 2ND FLOOR: D FL OR73 1(3/� - <br /> ESTIMATED CONSTRUCTION COST: G <br /> (Please round to nearest dollar) ..+ "► $ 3 3 5r J aq a : a� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [�No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 10 ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? �'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes C9 No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#/COcK' - ) (le. e blank if none) <br /> 6. Is a location survey required? (see reverse) Yes El No ❑Don't know <br /> 7. Is this to correct a violation? •Yes Ji o <br /> 1 ,'S t <br /> t, c <br /> "' APPLICATION on Back) -►MUST BE S ED <br /> IGN <br /> 545-112(4/08) <br /> (Continue <br />