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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 /> \ <04// ) STi<cf gee IN Zoning Status; CUP; <br /> OWNER ADDRESS Number,Street,City,State,Zip) De dd Restriction; CSM <br /> SA <br /> we 97 Dc t S we P-0 C 60 `.Lit 5-35- -/ Va ance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ‘c' 2,?oXV ,'U -5,6-Sy0/ r'Sir„e6Je f ;rt'fo3'c . c�c. ji S. Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> r� ` ” , .Cff 44q-4A, �ST n to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> /a C i S cra“6/71 Too u R”. <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> m 19,S6r,i 6-v' i 5.-3 7/C <br /> PHONE PHONE ❑ %ite Pla pproval from <br /> cc Y -- 222 - J applic le township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ca,ba,LiikNilyirlt9 601 HNi cc,,.9e, EX:--,N `'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) !J Elevation of prop <br /> PARENT PARCEL NUMBER: CURRENTZ ING: r ACREAGE: Elevation <br /> frontage draw scale. <br /> ❑PARCEL 0-50 17,91- aS • 1. 7 111 <br /> NUMBER <br /> ::::: SECTIO ❑ DriveWa ermits <br /> R '�Q �� ��' ��1/4 (state ounty •wn) <br /> �w <br /> 3 6, 6 I �� 'Y i ❑ Sanita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publ ', private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: , <br /> 2 70 S -F T g.47Pf/2,,„L.41 A 0 Tit'-i, 1 r onirtg District <br /> . ❑This project is a new building or structure. ■ Permitte ?` <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ddres(j\\EWER SEPTIC (new/e ti <br /> HEIGHT IN FEET n NUMBER OF STORIES: (Not i eluding basement) <br /> /d l'—'1- , y S/ r 7 ❑ Wetiand/F dplain/ <br /> Shore! (attac ent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErosionCo ol permit <br /> BASEMENT 1ST FLOOR: <br /> ?® Fr 07c S`` /' 7 1 TOTAL SQUARE FOOTAGE: 1 (slop7S, turuance, <br /> r filling/a ess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Re ew Location Sury <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 3 s L�Z and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies FiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies r�No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ElYes ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Lives Rio <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) Elves No ❑Don't know <br /> 7. Is this to correct a violation? . ❑Yes Rio <br /> ..1 �� / APPLICATION MUST BE SIGNED <br /> .,.;��:���� � Continue on Back ♦ -► � <br /> 545-112 0/08j \ I_i <br /> t <br />