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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 /> QI cX -w- i'4evnecz_ i C S_ a toning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> seed Restriction; CSM <br /> o?5O _6)o0.{ ill) 14• atien.elfi WI 53,5-07 Variance(# ) <br /> HOME PHONE �/ CELL PHONE E-MAIL ADDRESS �y <br /> ,•;-•, • ,5 'O ,C,-57 - , I , ■ 0 ^ �lal 1 • 1'90, <br /> Si Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION a includes dimensions <br /> AGEN NAME CONTRACTOR NAME <br /> 1 K�1� �i e.I 13 �,�fjr0�`�-� � - p,) ite Plan including location <br /> AG NT ADDRESS CONTRAC R ADDRESS f well/septic <br /> 3oa62 01 Du►> s view (ZP, 3(l0l'o Otutoks ✓i FcAJ RD <br /> (City,State,Zip) (City.State,Zip) [Setbacks <br /> ALve dipa,J5 lea- 535/7 11.ve Olowyks t. T 535/7 <br /> PHONE PHONE El i Plan app al from <br /> 67C6 _ 70- (05- &CV- 170 -(95-?? plicabl wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> - / 4 t . ii -e' kell .oes,Ug w • e v ,dp,t.t loor lans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Ele ation of property <br /> PARCEL NUMBER: CURREN ONI : ACREAGE: P Perty <br /> El PARCEL D/ �,?+b -9595 O fro tage drawn to scale. <br /> NUMBER l9 `j <br /> TOWNSHIP: SECT /� _ - <br /> 5 R 1 N €- 1/: 5 1/41/4: N '.� /veway permits <br /> ADDRES ( tate, county,town) <br /> a itary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p blic,private) <br /> PROPOSED PROJECT INFORMATION REVIEW <br /> PROJECT DESCRIPTION 1 /� [TAFF <br /> L -- A .. • 6 . V ) A .d f ( l_..1� • ,;t,ming District <br /> This project is a new building or structure. 01 Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: • -■ -I 'ddress <br /> EWER ip-EPTIC 13 aOI( _c 5-q (new/-xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Lr 9 re. 5-1-OP-A.)____ ❑ Wetland/F odplain/ <br /> &Tor (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 5: 1ST FLOOR: ❑ EtOSIOr1COn permit <br /> 4��i� V.1- L`7 Q (1 + TOTAL SQUARE FOOTAGE: j (slopes, ' rbance, <br /> �/ O�/ Jr�1J y� filling/a ess) 1 <br /> 2ND FLOOR: 3RD FLOOR: r7 q n <br /> g077 te ❑ R Ie v Location Surve 1// <br /> ESTIMATED CONSTRUCTION COST: <br /> ♦ _, ♦ ♦ -0. / i and available options. <br /> (Please round to nearest dollar) Q 017 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Y s o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es [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? [1'es • <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank !none) <br /> 6. Is a location survey required? (see reverse) [Yes ffl,4o [Don't know <br /> 7. Is this to correct a violation? [yes r' a <br /> 4c..), ,ss ? ' APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -, -to -► <br />