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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 'f T <br /> DA <br /> V ID L. v 0l6 I [✓]Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,state,Zip) • /I Deed Restriction;CSM <br /> 1'1 W esT 1l1ZD&J AVE (JE � 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ( Otte Plan drawn to scale <br /> �; -72.1 22'f-�029-(Ic .I delve e d-LVo1 •GOM <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> W IV Eta. 7�'A.ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,ZIP) <br /> (city,State,Zip) ❑Setbacks <br /> PHONE PHONE Ole-Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ii <br /> IC, t oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.usl) <br /> PARENT PARCEL NUMBER: CURRENT ZONING:e.co.daAnceR.EAWGi.Eu:S/) <br /> of property <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: ,,�, / SECTION: 4 <br /> L.$/oi '/: '/.'/4: 7�l riveway permits <br /> t,,� �t,.� (state,county,town) <br /> ADDRESS:1 12. ?OTO WAcTOM i D�• TO�I 53 ❑S .' -ry permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (publ' ,private) <br /> , DI' TS- <br /> PROPOSED PROJECT INFORMATION ,� <br /> PROJECT DESCRIPTION. '��' I �1 1 / t ' - � � <br /> ✓� + r'�A II / - a � i 'r �� `max <br /> . r x^- fir''a.,A - <br /> ❑This project is a new building or structure. » � <br /> This project is an addition/alteration to an existing building or structure. <br /> PERMIT NUMBER: <br /> ir4. 1111*HEIGHT IN FEET: f�1 N ` NUMBER OF STORIES: (Not inducting basement) s , <br /> 2✓- ii I , k <br /> ter -, -.� <br /> AR O NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) s � <br /> BASEMENT: 1STF OO , <br /> �C n •y��( j TOTAL SQUARE FOOTAGE + c <br /> 2ND FLOOR: <br /> 3RD FLOOR: O.O , <br /> ESTIMATED CONSTRUCTION COST: - <br /> (Please round to nearest dollar) ♦ "� "� ♦ '� '� .. , '•1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? .. Yes �Vo <br /> II Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes o r�:s on't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes '4o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes 10 cz.r <br /> 5. Is this project associated with arezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) <br /> Oyes [ lo �on't know <br /> 7. Is this to correct a violation? ❑Yes 'lo <br /> , "` -V`^ <br /> f C Y" Z ' (Con inue o MUST BE SIGNED‘4111, 4&ifea sits .. • (Continue on Back) -► -► -�tfaji‘rifi (1514Ait"fiji <br /> £-�'• C / y <br />