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ZONING PERMIT APPLICATION www.countyofdane.conl SUPPLEMENT'to We6•App #' <br /> PROPERTYOWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME/ n ce I n n i�� �,U 1 <br /> !lam vrA� '1' t I El Zoning Status;CUP; t <br /> OWNERADO�tESS (Number,Street,City,State;zl ) Deed Restriction;C'SM e <br /> X(15 (au r roc(U AtetISL1,s� l 53) i Variance(# ) �r <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (0R-C - diC6' roce rose 21 }mf(i 1 t(0 1 0 Site Plan drawn to scale I <br /> ,.,...»....ti V,6 <br /> 'AGENT INFORMATION CONTR�ICTOR�INR60!(�II A- 10 .:ti,�q::.�a,?:f3:i� and includes dimension-114,6 NAME CON TRACTOR NAME <br /> KSit • cluding location( ' 1/1 AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> ■ <br /> • (City,State,Zip) (City,Stale,Zip) Setbacks ' <br /> PHONE I PHONE fr Site Plan approval from <br /> 0C T 2 6 2015 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> ipf OPERTY/LOCATION,INFORMATION;'(http7%accessda_p0c Rut vyi e 010.2, ; i �f <br /> PARENT PARCEL NUMBER: q,�y� CURRENT ONING: ACREAGE: l� k Elevation of property I <br /> 11 PARCEL i,9)1-O2/- (�TQ ,' , -/ 0, 6 / 3 frontage drawn to scale <br /> NUMBER / i <br /> TOWNSHIP: <br /> CT r( 6 r SEC 0 <br /> 6 e5 <br /> 1/4: /" l_ WA: ..c w Driveway Its <br /> ADDRESS _ -- — (state, oun own) <br /> SG, '^- <br /> - %� 1 ,a .e .i is <br /> CSM: LOT SUBDIVISION•PROPOSED PROJECT INFORMATION '. .„ n / - ,j.. tM <br /> PROJECT DESCRIPTIO': <� 44"1\01:S2 .i(9'.(. <br /> This project is : ew buil.P or structure. (} ]��� `< '` a�,: <br /> • This project is an addition/alteration to an existing buildin ( 1 ;� •- <br /> C� <br /> SANITARY SERVICE: PERMIT NUMBER: e �� ,� � �� - <br /> nSEWER SEPTIC / U 3 .,,,iT0:HEIGHT IN FEET: NUMBER OF STORII ( •� • �' -� <br /> ? /� s'a11T/ r1'c(___ c,,i k :aefi` ent <br /> AREA TO NEAREST SQUARE FOO} �- YYP' o <br /> (Outside dimensions including unfinished area,attached garages ant, ( ( ,�[ 1 rr - <br /> perrrtl`; �.�i <br /> BASEMENT: 1ST FLOOR: V� p�-x2o 4` <br /> ! 1J L l� t�'�ane ; t 7 <br /> 2ND FLOOR: 3RD FLOOR: / _ "�' — -' t ~ C. <br /> 7U/ <br /> ;.:;-',:.'•r z-' <br /> ESTIMATED CONSTRUCTION COST: r�1�� r `, ? Gxp i ep �. <br /> (Please round to nearest dollar) -i ♦ --► --► ♦ uo ry' '�t�� , ._? , ` 4- <br /> 1. The property is within 300 feet of a stream or 1 .$ feet from a pond or lake? . --. Yes No 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes No n Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? -.-. nYes ,No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LJYes '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) ❑Yes 0 No Don't know <br /> 7. Is this to correct a lipiditiorge....20.15. 0Yes 1INo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) DANE COUNTY PLANNING&DEMO ENT (Continue on Back) -4- -* -4. <br />