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ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> CVtNER NAME n <br /> / �t�Wn Qf Gvht\ El Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> + \2 Cov.hS R1 !, MCFar!1c.r•cl,\►1I.1 S3S'S2 Variance(## ) <br /> HOME PHONE CEt_CPHONE E-MAILAbDRESS '1)613 <br /> (16g-$3`i-logl 6k2..o11tn6rolcl/ k1T-1111••a`4 r%.A3 . [..21 Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME n CONT°•C oR NAME <br /> 1.5tn kc\\Q'nt)re:cA te,r',+, Cr■ ;„ c.,,„{) Di Site Plan including location <br /> AGENT ADDRESS CONT-•CTOR AQ RESS i of well/septic <br /> { C a („),;k * <br /> M.Setbacks <br /> Ity,S��taRRte,Zip) `` \�,' 5--1S- c' (City,State,Zip) -} -C-9 <br /> PHONE PHONE i ®Site Plan approval from <br /> (00(b-V31" 1pct 4 ,.t2A ,20b CA- gi5--9--)©Q applicable township. <br /> E-MAIL ADDRESS ii E-MAIL ADDRESS <br /> b k akIt.t rn�� \t TO•IIh.r�w•,.,w;,v,,.S V t „�.,'Z cl t=r b•Ai���.. .co.^ ®Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) Elevation of property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: IN <br /> ONUMBEIR C?t,10,Z'Z_ 97 1p_1 rt. -i 1.9 frontage drawn to scale. <br /> TOWNSHIP: N SECTION': <br /> .KKI\n 2' 'A: /'/: :vay perm its <br /> (sta e,county, <br /> ADDRESS: d <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sani�-ry rmits 1� <br /> (pub'- private) "tin <br /> PROPOSED PROJECT INFORMATION REVIEW <br /> PROJECT DESCRIPTION: ��`` ] ^���,I� j + n <br /> !`e ,W evo.i(.,4,; ,na III er;cam' .CT9r,ve, &i 11 W' "rungDiatn <br /> . This project is a new building or structure. E s. <br /> , nod Use <br /> ]This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: - .. t ` <br /> EWER [ //EPTIC ( ex ' 'ng 3 <br /> IGHT IN FEET: .t r NUMBER'OF STORIES: (Not including basement) <br /> )9'5 A L 1jc -ko r't e 5-'l ❑ e ./ ...plaint <br /> Sho - - • attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gairages and above grade decks or porches) ` <br /> BASEMENT: I 1ST FLOOR: �° <br /> 7 J t C O Q + TOTAL SQUARE FOOTAGE: + 1,..+ + t then..-\ C <br /> / fiilling! ° : .1 <br /> 2ND FLOOR: / 3RD FLOOR: / O� <br /> 5'o Q o cReview Location survey <br /> ESTIMATED CONSTRUCTION COST: $ Q and available optI ns. <br /> (Please round to nearest dollar) ♦ ♦ }► O S QQ <br /> VO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes No DDon't know <br /> 2. is there a wetland or floodplain on or near the property? Dyes EiNo ODon't know <br /> 3. Have you talked with the township about your pros ct and are they in agreement? ®1'es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ONo <br /> 5. Is this project associated with a rezone/CUP (petition/appeal# 3b 7 3 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Tres ENo ODon't know <br /> 7. Is this to correct a violation? I OYes [ lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4108) <br />