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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU-TOMER TO PROVIDE <br /> OWNER NAME <br /> 0 04 44- ?l--- & ni nn--2 t/c7/'4v iK'�.e -' ` Z ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) —t�, Died Restriction; CSM <br /> 3 7 7'{o K' �/*,tG( /i0 ✓�j'I [ �w✓I I l" t /� ri ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,O$--' 35- 2 c 7 Udr i(/E 4 . /r/ '/ /' 6 ° r71 . e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGRJT NAME CONTRACTOR NAME 1 <br /> ncl4-// S/al�e,'� evi'/di' ('Otice,o, S S. e Plan including location <br /> AGENT ADDRESS CONTRACTOR RESS o well/septic <br /> 5/1/2'<-_ 1 So a '(oe,f s/e1e. G <br /> (City,State,Zip) (City,State,Zip) _ •' sacks <br /> Gt/ v/i/t�e-e 4/i 5 3 L 0l 7 <br /> PHONE PHONE <br /> III :ite Plan ap val from <br /> Coo — S-7 S-- 3�6.7 S applicab ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> f S bG i rt4 al ..)24-/.1. z v 1 ) Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER:`/ CURRENT ZO IN : ACR : re evation of property <br /> El PARCEL NUMBER O('0 v j 4/- 9, K0-( R /4° ont e drawn to scale. <br /> TOWNSHIP: SECT ON: <br /> b u n t 1/4: S E. 1//: N D veway permits <br /> ADDRESS: ( tate,county,town) <br /> 3 ") 55-6 e., f/ola.eLJg4 ?our, /ir . <br /> CSM: LOT SUBDIVISION BLOCK/LOT a ary permits <br /> S 9 Y 5' l (p b c,private) <br /> PROPOSED PROJECT INFORMATION iilled AFF REVIEW <br /> PROJECT DESCRIPTION:-- T ^ 1 - �< 70,iN C/� 1 <br /> (1 J � [rigC►istrict <br /> . OThis project is a new building or structure. 11 Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUral ` ®Glress <br /> EWER F$EPTIC ' ,1 �d ©1 (neWle i -• <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) <br /> 2 i ❑ Wetlandino plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela (attach t) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: '/ 1ST F =": ❑ ErosionCon I permit <br /> i CZ/8. 7 `„i yl,j 7': 1 TOTAL SQUARE FOOTAGE: j (filling/ ,' • turbance, <br /> ,( filling/ cess) 1 <br /> . 2ND FLOOR: 3RD FLOOR: <br /> R49 ,--. 6'/ 3 ❑ view Location Surve <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ Q and available options. <br /> -P ♦ ♦ ♦ <br /> (Please round to nearest dollar) $ A 0� &, 0 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es o QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? es N ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es ❑ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank one) <br /> 6. Is a location survey required? (see reverse) QYes ❑Don't know <br /> 7. Is this to correct a violation? EYes o 2./a <br /> / APPLICATION MUST BE SIGNED <br /> -.'” ( (Continue on Back) -► <br /> 545-112(4/08) ^-�-�- � <br />