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ZONING. PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> AJ 1 Spots lc c4 ,4 6■44/1 >",c ,- Zoning Status;CUP; 41 '/ <br /> ,. <br /> OWNER ADDRESS (Number,Street,City,State,zip) Deed Restriction;CSM g / <br /> a <br /> 26 io 6--1Adleje d.J Variance(# ) <br /> HOME PHONE CELL PHONE EAAIL ADDRESS <br /> WE e39- DIS7 60e --.241--.29 1 6 -Nil t • $,v.ii A to 10 Aft tkcr 2 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 4 <br /> AGENT NAME CONTRACTOR NAME <br /> Eij Site Plan including location h.AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ,e i Setbacks 3 OA 0 /+ 6"D <br /> '38 <br /> PHONE PHONE Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> e 1 r / / —2 /3 _3 Z/ _ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) leNation of property <br /> ElPARCEL PARCEL NUMBER: ,�+ cuRRDtNT ZONING: ACREAC C frontage drawn to scale. <br /> NUMBER O - - °I tS T.- I (/�Jr <br /> TOWNSHIP: (/` SECTION: {'J// Jay/ All , <br /> -0 A ck r �l Ig-0 J C Z. / 'h: " " %%: ' " (state au�/ <br /> ADD SS: <br /> (0 I f) GLA•‘ e J t 0 P A EiSanita <br /> CSM: �^ LOT - s nn ,f/i k a `w (publi p• ate <br /> J <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ((�� L �� <br /> C AJr ( `1'Aa k1� PS C.c 4 - Zain • <br /> . This project is a new building or structure. Ube? <br /> This project is an addition/alteration to an existing building or structure. nelif <br /> SANITARY SERVICE: PERMIT NUMBER: ill Rum '" <br /> EWER p4EPTIC ( 1{' "717`iv <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (�including basement) <br /> AREA TO NEAREST SQUARE FOOT: ) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 3 / TOTAL SQUARE FOOTAGE: l ( , P <br /> ::) <br /> 2ND FLOOR: 3RD FLOOR: 3 So J <br /> L�iaw L oCatiOn Survey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ Q <br /> (Please round to nearest Wit) - $ 5000 t 00 B <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ao [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Flo ['Don't know <br /> 3. Have you talked with the township aboutyiour project and are they in agreement? [Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ao <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location enigey required? (see reverse) ,. ..t [Yes o ❑Don't know <br /> 7. Is this to correct a violation? [Yes to <br /> APPUCATION MUST BE SIGNED <br /> (Continue on Back) -► -. -► <br /> 545-112(4/08) <br />