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I <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN� � Eel/ I `� , i I be i� <br /> YY Zoning Status;CUP; A r/ <br /> OWN SS((N/umber,Street,City,State, ) Deed Restriction; CSM <br /> oM� �^' !jf/ISIN 1 '�� rp, , , <br /> �gl /I C 6LJ1 .S-0-TO Variance(# ) <br /> ON „ CEIL PHONE E-MAIL ADDRESS ) <br /> " � 1}'°t Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME COJV]RA TOR,NA)'' _ I^d� IM ,r <br /> //J//�Cp. 1U�11 v) W1 11 ' ��t /j,�Jc�l Site Plan including location <br /> AGENT ADDRESS CONT CtTORAD E S of well/septic <br /> 1 e-6b (-e, I ra0K T✓ . 6'z d 3 <br /> (City,State,Zip) (Ci ateF Zip) Setbacks / / <br /> 6 �(ot I r^i W-1' , mil C -�' Q/�%�/S^d <br /> PHONE PHONE / ❑ Site Plan approval from• <br /> �f o�, g�/� applicable township. <br /> E-MAIL ADDRESS E-MAI ADDRESS / <br /> IA .Li �� Y�f✓l-�f o Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdan.e.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL MBER: CURREN ZONIN ACREAGE: P P y <br /> ❑ PARCEL e71,r��O(�') _ f q1 _ �`1iUaR 1q I J �] 71 frontage drawn to scale. <br /> NUMBER /' _I / I �/1�'� ('f 1 <br /> TOWNSHIP SECTION: '/a 1 <br /> /' : 141%. _ Driveway permits /it <br /> ADDRESS: /� ( C, , > q (state,coun o ,u <br /> 1 ` `co in ail{�i �t i L/ ai'vi W= 535/D Sanitary per its S 7 ij 35 <br /> CSM: LOT t S DIVISIb / BLOCK/LOT (publi � '� <br /> b soy , , <br /> PROPOSED PROJECT INFORMATION '$'>AF REVIIEW" <br /> PROJECT D SCRIPTION: , <br /> ebt) Q 0 4 or l�L c/ i1=t Zoning District <.A ,.,:' <br /> 53/This ro ect is a n uildin or structure. <br /> P 1 9 Permitted Use? ' <br /> ❑This project is an ad ition/alteration to an 1 isting',building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: l joi - ' -I Address S o 1 ty <br /> ❑SEWER %EPTIC Z Q - ✓ , ' /existing) c::: <br /> HEIGHT IN FEET: —7 NUMBER 6F STO S: (Not including basement) � '"'-"`�� � <br /> / / wetland oodpiatn! <br /> Shoreland (attachment)t4(‘//4_, <br /> AREATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOD: c Z rosion ' ntro1 rmtt <br /> /�z� �./ 4 TOTAL SQUARE FOOTAGE: 4, ,' lO?e ciess r , e.. I� <br /> pilitng/aooeSS}k N <br /> 2ND FLOO�• , > 3RD FLOOR: $ j /� , <br /> eview Lsa#Ittxnrey <br /> ESTIMATED CONSTRUCTION COST: 'n�L and available o bons 6�2i .,9 <br /> (Please round to nearest dollar) ♦ '♦ ♦ ♦ ♦ Qvv <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 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 surrey required? (see reverse) F es No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112 tame) <br /> (Continue on Back) -* -► -s <br />