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ZONING PERMIT APPLICATION www.countyofdane.cotll SUPPLEMENT to.WebApp <br /> PROPERTY OWNER INFORMATION -. Cu•TOMER TO PROVIDE <br /> OWNER NAME p // <br /> �f/413 / • K 644 EXC A i.J V Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ed Restriction; CSM <br /> o?O O e2 S#q,✓o,-u uLC. Po . ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60 r . , .6a//6 Apr '.f'-• /4 .J I ". L .c(.t .4t*I t_ •e w_.. <br /> Si Plan drawn to scale <br /> AGENTtINFORMATIOltI ,r, ;3 .CONTRACTOR INFORMATION, 4, d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE D S e Plan pp- royal from <br /> pplic e township. <br /> E-MAILADDRESS E-MAIL ADDRESS ,,��,,/I <br /> [4loor plans to cafe <br /> PROPERTY/LOCATION"INFORMATION ;f,(httpe//accessdane co,dane wi.us/) ��V��VJJJJ <br /> PARENT PAR. EL NUMBER: CURRENT NING: ACREAGE: ❑ Elevat of property <br /> DPARCEL Z Co/O- ?k- 6 h( ^ 0 a front ge draw -to scale. <br /> NUMBER 1 <br /> TOWNSHIP: SE I)1 <br /> n '11 : /. N i y: : ❑ Drive permits <br /> ADDRESS: 1 (stat , County, town) <br /> /- <br /> 01d002- .Sd.✓a ffr4c. RO • O !L£6 eovu D Sanita ermits <br /> CSM: �� LOT SUBDIVISION BLOCK/LOT <br /> (pub'c, private) <br /> PROPOSED PROJECT INFORMATION 's STAFF REVIEW j <br /> PROJR'CT DE RIPTION: ` �`i' <br /> ' C e $ 1) :� <br /> � y� �o�ng�Dlslract�° s <br /> • DThis project is a new building or structure. F� 1 mltted�Us '�a <br /> This project is an addition/ eration to an existing building or structure. F-41 i s,:3� `- <br /> l,,Mess} _X' <br /> SANITARY SERVICE: PERMIT NUMBER: \ �. F � <br /> [)EWER EPTIC �(/��J1 A g nagNO stlpg .,, ▪ 3 <br /> HEIGHT IN FEET \ NUMBER OF STO�IES: (Not includi g basement) - r�4 ▪ - <br /> 4©t.1/Uetlat �/FIOe e 1tifig_ �"� <br /> ASho?e1�p atttachment) <br /> AREA TO NEAREST SQUARE FOOT: 3 <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - f<4144.11 :757-4,a r <br /> .��-ECosaotCo per�lt <br /> BASEMENT • 1ST FLOOR: Y <br /> 1 TOTAL SQUARE FOOTAGE ,1 `'Ns1ope ai,ULbance, + <br /> 2ND FLOOR: . 3RD FLOOR: -Im acC4.S0 ' ,_ <br /> Revises LocatIt Suie _ <br /> ESTIMATED CONSTRUCTION COST: ` n bi _ <br /> s -- <br /> " '� I �� K. 5 ..a a r ,(Please round to nearest dollar) _4: R; 1 t _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [' ]Yes DNo DDon't.know <br /> 2. Is there a wetland or floodplain on or near the property? [ Yes ENo .['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [MYes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes NINo . <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 jNo DDon't know <br /> 7. Is this to correct a violation? DYes VINo <br /> . 14 Co /4 q APPLICATION MUST BE SIGNED <br /> (Continue on Back) —* -+ —► <br /> 5455-112(4/O5) <br />