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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU=TOMER TO PROVIDE <br /> OWN NAME <br /> hOane Gro55 a teed oningStatus;CUP; <br /> OWNER ADDRESS(Nlimber,Street,City,State,Zip) <br /> " _ Restriction;CSM <br /> HOME PHONE W ELL PHONE �u n E-MAIL rADDRESS riance(# ) <br /> COS— 839_ // aog- 358-8uo8 r. 0 l ../=r,,,>t'er . Caret ePlandrawntoscale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> (City,State,Zip) (City,State,Zp) jacks <br /> PHONE PHONE PI approval from <br /> ble township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of pro <br /> PARENT PA EL NUMBER: CURRE ZONING: ACREA P <br /> ❑NPARCEL UMBER <br /> ©1/( - 10 - 9.800 d) _-( 30?-- 9D. frontage dra o scale. <br /> TOWNSHIP() Si-0 SECTION: <br /> Uri S / o ) _ '/4: r wh: V ❑DrIV y permits <br /> ADDRESS: ($ ,county,town) <br /> 7.54/3 /)w j ‘11/ San Prairie WI: ,535W0 ❑S- ' --' permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (yi IC,private) <br /> PROPOSED PROJECT INFORMATION : APR REVIEW <br /> PROJECT DESCRIPTION: �/ � n <br /> I /� 1(1 liNe M • ing District <br /> This project is a new building or structure. ❑ Permitted <br /> ❑This project is an addition/ eration to an existing building or structu e. <br /> SANITARY SERVICE: PERMIT NUMBER: El Run ' ,1 <br /> EWER EPTIC (n@W/e 4 Sb '' <br /> HEIGHT IN FEET: i . NUMBER OF STORIES: (Not i acing basement) <br /> S f 1.3 wade • •• • _:n/ <br /> S • _- -, • (attach ), . <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Li Eros i <br /> permit <br /> BASEMENT 1ST FLOOR: <br /> on ,, °, <br /> 6 CP(J/ti V j TOTAL SQUARE FOOTAGE: , (Slopes ' sturbance, <br /> 2ND FLOOR: 3RD FLOOR: f full F - ) <br /> �.0 6 0 0 ❑ Review Location Surve <br /> ESTIMATED CONSTRUCTION COST: —• -► ♦ ♦ ♦ ♦ G c and available options. <br /> (Please round to nearest dollar) $ 15 600 — <br /> ) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes slo [on't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes Dlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EgjiNo <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) Elves 1 o °Don't know <br /> 7. Is this to correct a violation? ❑Yes F,I, o <br /> APPLICATION MUST BE SIGNED <br /> 545.112(4V8) <br /> (Continue on Back) —0, —► <br />