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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN A I <br /> OWNER ADDRESS NGmber�,Street,City, Zip) <br /> ❑ Zoning St ; CUP; <br /> Q Deed strictionr_CSM <br /> U T ���'. 1 / 1)��-a/ ( ).,.— - .�3 ��T 3 fri rice(#HOME PHONE C LL PH NE E-MAIL ADDRESS <br /> ❑ e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGEN 4; ME �`{�/1l/I CONTRACTOR NAME <br /> AG• ' Sle Plan including location <br /> ADDRE• CO TRACTOR AbDRES�9�� / o well/septic <br /> 8819 W /1- pcs , i80 g3na_p-o <br /> (City,State,Zip) (City, ate,Zip) etbacks <br /> lieiun <br /> ra. / GdJ.`o : 53W-3 VJZzUn.G_,t4)./i,- 5-3 5-9' 3 <br /> PHONE PHONE ❑ Site Plan proval from <br /> toorg-e302 -itT9 0 oD -373 -5-.-570 appli le township. <br /> AILADDRESS E-MAILADDRESS <br /> ❑ loorfo scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: ^ CURRENT Z NIINNG: ACREAGE: Elevation of property <br /> ❑ NUMBER ��O ���°� ,a)0 Q d` S, q frontage drawn to scale. <br /> TOWNSHIP: (0• t 1�' O SC!S 4: /V J , 1/4: IV VA/ y <br /> 1 y ❑ Driveway its <br /> ADDRESS: p r H (state, unty,town) <br /> S38s C A ❑ Sanita <br /> CSM: LOT SUBDIVISION BLOCK/LOT ry <br /> pe <br /> /© 7. , (public vate)s <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ,�/ e ' \- ' n E mg District <br /> E(This project is a new building or structure. <br /> termitted Use?;, <br /> ❑This project is an additio Iteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Mira/ : '.- <br /> ❑SEWER SEPTIC (new/: 'hall, <br /> HEIGHT IN FEET: 02©I NUMBER OF STORIES: (Not including basement) <br /> ❑'Wetfati o ...,o 6 nt - <br /> AREA TO NEAREST SQUARE FOOT: S a - -e �°_ <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ on <br /> BASEMENT: 1ST FLOOR: <br /> y© O <br /> 4 TOTAL SQUARE FOOTAGE: 4 ''s 3 ,d r@ x ':,,,,..ifs.- <br /> 2ND FLOOR: 3RD FLOOR: <br /> 4s(0--1 c 5,1` <br /> 4. Fievtew Location:6ufv�ey- L <br /> ESTIMATED CONSTRUCTION COST: -�► -.► -� © and av�-�b (� <br /> (Please round to nearest dollar) O L� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a and or lake? ❑Yes � <br /> P o CI Don't know <br /> ❑ <br /> 2. Is there a wetland or floodplain on or near the property? Mes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? al Yes ❑ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes Jo / Oq <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank yf n .It`,,S .,' , <br /> Q/ t , <br /> 6. Is a location survey required? (see reverse) ❑Yes ro ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> .4 �_ , APPLICATION MUST BE SIGNED <br /> 545-112 (Continue on Back) <br /> (4/08) <br />