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;SUPPLEMENT to Web App;# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY;OWNER INFORMATION i. ;- .F. c STOMER TO PROVIDE <br /> OWNER NAME ,• / / <br /> /'t' ' 1 v try p Zgning Status; CUP; <br /> OWNER ADDR ' (Number,Street,City,State,' ' ) ' geed ROStrICtlOn; CSM <br /> HOME CELL 190N O � �-ADDRESS - lance(# ) <br /> G (imo3`"C. Ahho- /O C :ite Plan drawn to scale <br /> AGENTIINFOR(NATION -W - ..e,: ;CONTRACTOR INFORI,AgTION_ •nd includes dimensions <br /> AGENT NAME CONTRA TOR NA)VIE 1 <br /> Cp(4 n.e-67 Ce,/, /'' 77'c/L ` ite Plan including location <br /> AGENT ADDRESS ONTRACTOR ADDRESSPO • ��,, of well/septic <br /> (City,State,Zip) (City,state,Zip) , Yi Setbacks <br /> PHONE PHONE <br /> 60? 711 - Mg Plan oval from <br /> Mg .pp. le township. <br /> E-MAILADDRESS E-MAIL ADDRESS - <br /> !4 Floor plans to scale <br /> PROPERTY/L_OCATION I,NFORMATIONP:=(httpi//aeeesudane co,dane.wi:us!) i Elevation of property <br /> PARENT PARCEL NUMBER: CURB NT ZONING: ACREAGE: <br /> 0 PARCEL NUMBER D 2 ,123 " 187- ilf"/ /,�S frontage drawn to e. <br /> TOWNSHIP: L �/ SECTI N: ' . l <br /> �C�() `7 E� 1/ai 1/4%: - �J ❑ Driv ay permits <br /> ADDRESS ..7...s c O v h� t ate, county, town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ (p a i +'amps <br /> (p a Ic, private) <br /> I <br /> PROPOSED PROJECTS INFORMATION - TAFF REY1EV , <br /> PROJECT DESCRIPTI I 11P r r <br /> R ,34../ D ,21 <br /> / ; -cSi <br /> . MTh's project is a new building or structure. I, te(mift�ed[JS�, ° =i :' <br /> a-. * -j <br /> ❑This project is an addition/alteration to an existing building or str ture. is t 7 ; <br /> SANITARY SERVICE: PERMIT NUMBE `+ _ <br /> C��R�,r�� ,fix � } �. �-� <br /> {EWER PEPTIC V v =g X0:04. ►1S hlt a <br /> t <br /> HEIGHT IN FEET ) O / NUMBER OF STORIES: of including basement) a } '4A._ E- - <br /> 0 Wetland/F` m plain/ <br /> r � 5 _ <br /> Ball d` attgi e ) _ <br /> (Outside dimensions including unfinished area, attached a ag sOaOnd above grade decks or porches) 4404' ' - -' - ' ' `. <br /> BASEMENT 1ST FLOOR: E[OS70nGOn'r9 rmit�• /zi :j TOTALSQUAREFOOTAGE ,j _ ` S�l)IeSe urbat�c�;- <br /> 111 4��^ ,�- .�,— <br /> 2ND FLOOR: 3RD FLOOR: /t <br /> Rev-tev_�'Looattt�n 5090.+ ,_�` <br /> ESTIMATED CONSTRUCTION COST: jJ _ arrd*41ga Ile 5,11 7 S,�s <br /> (Please round to nearest dollar) ♦ 4. -i --► --► . $ 7U j - _ :_ € r L <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ENo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes No .['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes EINo. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? Dies , ]No <br /> . . _____L4 . . <br /> a APPLICATION MUST BE SIGNED <br /> 545-112{4/06) <br /> /G (Continue on Back) -O. -► -* <br />