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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> otMER NAME <br /> M. V AV 6^v`.r 4 t oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City, e,Zip <br /> �( Deed Restriction; CSM <br /> ' I l 2'q 3 S v`` S {- , �or Variance(# ) <br /> HOME PHONE PHONE E-MAIL ADDRESS <br /> • i I Z ur Z 131,4-Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and i udes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> At-A.v( u_s (01 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS n of well/septic <br /> (may.State,Zip) i IJ"1 J c e ' y <br /> (c sat zip) etbacks <br /> PHONE V� �a~P S � w , J S�3 <br /> PH„E 0 Site Zen a royal from <br /> (O G% ›cl 6 2. 6 6 app township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> A w d re.I., s c o. (( c. Ir.....1 41.Ri &plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUTENT ZONI ACREAGE: vation of property <br /> u PARCEL <br /> NUMBER 6'7 I (-ii 3^71-2-S-4 - . ---9-19 t . p, d frontage drawn to scale. <br /> TO SHIP: SECTION: <br /> t 4it ove. a—(seat_ . _ In: '/a'/.: 4 e rmits <br /> I AD RESS: (s t nty,town) <br /> CSM: LOT UBDNISION BLOCK/LOT anita rfTlitS <br /> V A (pub!' p bate) <br /> PROPOSED PROJECT INFORMATIONAFF REVIEW <br /> PCT DESCRIPTION: <br /> nn 1 <br /> V t•-•tc 0 o w. d(� I I-t dy` onl istrict <br /> • This project is a new building or structure. <br /> Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> ANITARY SERVICE: PERMIT NUMBER: te7itted <br /> Add•_ <br /> EWER ' PTIC (new = I sting) <br /> HEIGHT IN FEET: / )- t)s- NUMBER OF STORIES: (Not including basement) plain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shore - : -ttachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) • C• lol permit <br /> •BASEMENT: 1ST FLOOR: <br /> 1.- C, j TOTAL SQUARE FOOTAGE: j (SIO•- -, •'�,urbane, <br /> Lr fillip• access• <br /> 2ND FLOOR: 3RD FLOOR: <br /> Z/v_ <br /> iew Location Surr y <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► ♦ ' l5 b 6 0 and avails tions. u <br /> (Please round to nearest dollar) O 0 <br /> _� VJ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes 11; o Jon't know <br /> 2. Is there a wetland or floodplain on or near the property? es I►, o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes DNo <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) Dyes fg,o ppon't know <br /> 7. Is this to correct a violation? :Yes I o <br /> APPLICATION MUST BE SIGNED <br /> 545-112 gavel (Continue on Back) -► ■ -► <br />