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_ONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 7-6-, ,�[ <br /> PAVI�4 ,�ut[Cz, PA civty, Li Zoning us; CUP; <br /> OWN ADD ESS (Number,Street,City,State,Zip) De estriction; CSM <br /> GoQsl� C Q v4.j,., dance(# ) <br /> H MEPHONNEE ICEL PHONE MAIL ADDRESS <br /> P?s 1°" 2.7 f 7 t— !'7 of ( Qc44,1t./•01 L "Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME /.... CONTR TOR NAME <br /> U W PJ R W fQiV- Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑ Site Plan roval from <br /> appli le township. <br /> E-MAILADDRESS E-MAIL ADDRESS ,/ <br /> o r—OQ„ ^ _ `, 9- S t Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENTZONI ACREAGE: ii/Elevation of property <br /> ❑ PARCEL R -I >3 �cl frontage draw to scale. <br /> NUMBER OW2/(� ?)5 —/Ti—;_6191°— ` 0Z <br /> 3Z3 <br /> . 0 v,e.101✓ %.f' '/: 3--4) %%: /Jui ❑ Drivew permits <br /> ADDRESS' / (sta ,county •wn) <br /> 9 c? �2!Cio i/"J ❑ Sanitar •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> M lsU, 1/01 (p bli•, private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 1 roar voay1, /GN,,nfr• ,,atot,4,r.. ze, t--tt, ire,to cte 'oning District <br /> . ❑This project is a new building or structure. Permitted Use? <br /> er.This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ��nn PERMIT NUMBER: ❑ RUra��Cd <br /> ❑SEWER` ASEPTIC '-S/� (new existing <br /> HEIGHT IN FEET: / // i �`` NUMBER OF STORIES: (Not including basement) <br /> Y ❑ Wetland/F odplain/ <br /> Shore! d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Eroseio trot permit <br /> 1,/? 3J 1 TOTAL SQUARE FOOTAGE: 1 (slop ,disturbance, <br /> )) � Ilia /access) <br /> 2ND FLOOR: 3RD FLOOR: L/ 7 ? �.,_-) ^ <br /> 17 }) 21 � Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ © and available options. <br /> (Please round to nearest dollar) f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li Yes 0,No ❑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? <br /> Lis o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) e blank if none) . <br /> 6. Is a location survey required? (see reverse) s ❑No pon't know <br /> 7. Is this to correct a violation? ❑Yes ' No <br /> -41 AD APPLICATION MUST BE SIGNED <br /> (Continue on Back) —, —► —► <br /> 545112(4/08) — <br />