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;; ENT SUPPLEM to Web App; # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION s_. „,; s _ ; r. ._ .> -:,r.` CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �.4- �� �C97 <br /> ����� <br /> — ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re ric n; CSM <br /> 1 %_ - <br /> ,,. ' Variance( ) <br /> �© RESS <br /> HOM PHO E • E MAILADD <br /> �i ^li <br /> �� J► - -A ' _. ' /.�,�� f E- Site Plan r n to scale <br /> AGENT INFORMATIOIt1 ., .:, ;CONTRACTOR INFORMATION ,,;, and inclu s dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan .nc ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se lc <br /> (City,State,Zip) (City,State,Zip) D Se asks <br /> PHONE PHONE D Site Pl•, -•gl a4.from <br /> applic!. _to n hip. <br /> E-MAILADDRESS E-MAILADDRESS <br /> D Floor p to scale <br /> ;.PROPERTY/L_OCATION INFORMATION :f(httpel/accessdane■co,dane wi.us!) '; Elevati of perty L.PARENT PARCEL BbR: CURRENT ZsNING: ,-.ACREAGE: <br /> DPARCEL �.0 B / ^ � frontag awn to scale. <br /> NUMBER L <br /> TOWNSHIP: - SECTION: <br /> • <br /> '/a: %1A: D Drive a mits <br /> ADDRESS: (stat , , own) <br /> • D Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, I t <br /> PROPOSED PROJECT INFORMATION <br /> uu��ff INFORMATION; A• STF R"E�.IEW <br /> PROJECT DESCRIPTION, / �y3 ' Fr y <br /> l <br /> sv l ,/ .,n . <br /> . ]This project is a new building or structure. l Perml Ue's 6 <br /> 0This project is an addition/alteration to an existing building or structure. {g�W�� t <br /> 0 Ru' -a e xessAj 3 4 L4. <br /> SANITARY SERVICE: PERMIT NUMBER: /,�� r� 1,}� , �, t 3 r. <br /> FTEWER IC • _4:t -$ 0.,r <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) • z :W . <br /> Q WEtlari• FI is .laln/;1 <br /> V� Shoo • ) <br /> AREA TO NEAREST SQUARE FOOT: ri�!ept <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches). �__ rr <br /> BASEMENT 1ST FLOOR: q n bin , El q • .a pet it .` <br /> O�U I TOTAL SQUARE FOOTAGE ,j `�5� ,. b,. arjJafic ; . <br /> 2ND FLOOR: 3RD FLOOR: �ICZ9 C/ I/� /,• ''-"1 <br /> ••ESTIMATED CONSTRUCTION COST: O Revs ,; ®.r� StJrVey <br /> 4 <br /> (Please round to nearest dollar) • ♦ ♦ --► -0. $ 6,000 r g.i 4 6 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes Mo • DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? 4aes ENo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? E,Yes DNo. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes R.110 <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) Dyes SIN Don't know <br /> 7. Is this to correct a violation? DYes .1r4 o <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4108) . <br />