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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1 r 50400\00\ 0 i5TRI�T I6 CI Zoning St ;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed striction; CSM <br /> /0173 Lc f-I% 't' 114 Mttzorhii-Nta LOT S3— a . nce(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> ( •A 76 -a 'S s a e,'- , 3 . . .L4-)Z- CIS Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AG NT NAME CONTRACTOR NAME <br /> k ftQLt. ❑ Sit 1 • cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Of /septic <br /> /'%?—c`j/ 41-A-ii E (.c2I .53560 <br /> ( ity,State,Zip) (City,State,Zip) etbacks <br /> PHO E PHONE CI Site Pla proval from <br /> (,o ) 7‘7-2 -9$ ErT7,ag _ pplic le township. <br /> E-I ILADDRESS E-MAILADDRESS <br /> ize1f E e Cults riw �l.2_CJ� 45. floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREA P P y <br /> PARCEL ����// ��..�� q1 /n� / frontage drawn to scale. <br /> ❑ NUMBER �`�9l� 'dVV��53' /"T` lE�(� a c ? g <br /> TOWNSHIP: SECTION: <br /> CI Dri ermits g t pt� Pa.-81;i PT 1/4: � /1/4:►'� (St ounty, <br /> town) <br /> ADDRESS: <br /> 0113 kS H" ly Mnzom4t - ❑ Sani permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ( lic,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PR CT DESCRIPTION: J � <br /> � IJ ��5E— �" Q h ♦ ► nfng�iszrt <br /> (�l This project is a new building or structure.�1 Permitted Use? <br /> ❑This projec is an addition/alteration to an existing building or structure. <br /> SANITARY SERVI PERMIT NUMBER ❑ Rural ' t® SS <br /> EWER ❑SEPTIC (new/-Acting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 30 X S() Li Wet)an *atn <br /> AREATO NEAREST SQUARE FOOT: Bf ¢t7i11eT1) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ vsiDD° <br /> BASEMENT 1ST FLOOR: <br /> S b <br /> 4, TOTAL SQUARE FOOTAGE: i-',:. iti ;,! <br /> �� g®lat;'QQ55�� �i <br /> 2ND FLOOR: 3RD FLOOR: /COO � F� _ � Review� `� �;:iSurvans e <br /> VVV T�ESTIMATED CONSTRUCTION COST: -•► -�► _o. --► $ and t e o <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ien$lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑ es N ❑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? CI Yes No <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) Lives No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i ■ -► <br /> 545-112(4/08) <br />