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I <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N E In <br /> 1 w aX& (IA LYE Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Str t, tty,State,Zip) y <br /> �C — Deed Restriction;CSM <br /> Variance(# <br /> HOME PHQ,l NEE C LL PHONE E-MAIL ADDRESS <br /> C <br /> 6,01g ` " 7"4' 5 7 le Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION .nd includes dimensions <br /> Aqatii NAME NAME <br /> (�(ti I rQ t j d 0 Site Plan including location <br /> AGENT ADDRESS ` CONTRACTOR ADDRESS •f well/septic <br /> (c�v t,3 t (O— 5 3 7 D (City,State,Zip) __--------' Setbacks <br /> L <br /> PHONE PHONE .` Site Plan approval from <br /> 67 s– 3 33 - 3a-tat) (cell) applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> acres Ya e 0 wl:se'1'44u door plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wri.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> UMBER n'6)t^ % i 1%(20 0 A -J f,' /,5 frontage drawn to scale. <br /> TOWNSHIP: SE T13.0 <br /> �(�t In 1/4: W 1/a1/aS n Drivew- p•rmits <br /> ADDRESS: (state,c. , ty,town) <br /> 3q'ep. tin 1) anita s.-rmits <br /> CSr:3 LOT SUBDIVISION BLOCK/LOT <br /> 0 7 �� ub' , • 'vate) <br /> PROPOSED PROJECT INFORMATION STAFF IEW <br /> PROJECT DESCRIPTION: '' <br /> (/je l I.G) e-cjL ) )c) 1 35kZoning Distrft<t <br /> ❑This project is a new building or structure. errnitted Use?:, <br /> '2 This project is an addition/alteration to an existing building or structure. y <br /> SANITARY SERVICE: PERMIT NUMBER: RUraI A-.' <br /> ❑SEWER In SEPTIC , <br /> HEIGHT IN FEET: ��D NUMBER OF STORIES: (Not including basement) <br /> Sh®y A. <br /> AREA TO NEAREST SQUARE FOOT: tt #tment). <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ® B Q kj F;($ . P <br /> BASEMENT: 1ST F s$ - e . r <br /> . , <br /> ,l TOTAL SQUARE FOOTAGE: j , <br /> 2ND FLOOR: 3RD FLOOR: s $ �' <br /> Alii Revi 1 °.41;tidpSurveY <br /> ESTIMATED CONSTRUCTION COST: , - . ` ` <br /> (Please round to nearest dollar) "� _■ -0. -� "-∎ $ 5� and .. f e ions. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 21No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes DIENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? UPI-Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <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 L.No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes -No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -0. -4 <br /> 545-112(4/08) <br />