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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 /> y ,��/ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 10 eed Restriction;CSM <br /> 3 w Q© Cpu a r/ 6/u ' .!j'IGv,elsi c f,/4- 535/7 variance(# ) <br /> 'CELL PHONE <br /> HOME PHONE E-MAIL ADDRESS <br /> W(8'6:36-3w 3 same 144 c and wad i.Cr»'1 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A LMT.NA#tE CONTRACTOR NAME <br /> y ith C it oI'a 5 14 h.e ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ��,99�� 3 0115 POC u late Z <br /> (C�1(4 te,tp) (City,State,Zip) ❑Setbacks <br /> Ng Cabo C;Ly (4.1. <br /> PHONE PHONE AN Site Plan approval from w/ <br /> 60th 77; -35'9 - •wnship. !r f� <br /> -1-4-1111Alt ADDRESS E-MAIL ADDRESS <br /> i MI Floor plans to scale ne4 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMB R: CURRENT ZONING: ACREAGE: , ❑Elevation of property <br /> ❑ <br /> NUMBER <br /> 070 a9'1 solo-O /4 I �� , 7 / frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> t)et ni 0 4.--- -�'r4: Ni/a 1/414: /0 e yy N Drivewa •-rmits <br /> (state, OUn town) <br /> ADDRESS: <br /> 300 Cou +fir ■' 1 F P[Ue ' tn,�t s 1 535%7 <br /> CSM: L T I SUBDIVISION BLOCK/LOT ❑Sanitary !_�I< <br /> (public,t <br /> PROPOSED PROJECT INFORMATION ,,; t 77177- , ' , k <br /> PROJECT DESCRIPTION: / <br /> 5hCO - ' '5� x 74 ` �„� � <br /> . EIThis project is a new building or structure. , <br /> 4 , *) i s <br /> This project is an addition/alteration to an existing building or structure. �. F ��< h1 <br /> SANITARY SERVICE: PERMIT NUMBER x 41-1::, <br /> 5� <br /> - $4 b� <br /> EWER [)EPTIC k� � t '' e O�i 'e4 t I___Icv_ct n II-- a <br /> HEIGHT IN FEET: , NUMBER OF STORIES: (Not including basement) T :. <br /> AREA TO NEAREST SQUARE FOOT: 1 `r. ei "' . i' g;#' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> j <br /> BASEMENT 1ST FLOOR: <br /> 3(e O 4 TOTAL SQUARE FOOTAGE: 4, _ <br /> 2ND FLOOR: 3RD FLOOR: ; �'� <br /> 3lDy0 € '° f) a t , 4: <br /> ESTIMATED CONSTRUCTION COST: ��yy��,, /� t ` <br /> (Please round to nearest dollar) .. F .4. "� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes NIClo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't kngtr <br /> 3. Have you talked with the township about your project and are they in agreement? Qt es to to (4e iv <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'lo /H gre fv I <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 alo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes IRINo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► —r <br /> 545-112(4/08) <br />