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. - ,1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com `SUPPLEMENT to Web:App P' <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAM //' • /� <br /> 6 tS Lc ' ning District <br /> WNIRRADDRESS (Number,Street,City,State,Zip rr^v,�4 I !e �, , <br /> NHOv s— � � �� • E-MAIL(A-�D//(D`,R�/JE/S/S < < ermitted Use? <br /> X08— �31.— 821 <br /> oning Status; CUP; <br /> AGENT INFORMATION ' CONTRACTOR INFORMATION' Deed Restriction; CSM <br /> AGENT NAME CONT CTDR NAME n <br /> �� r-G oboe ff -W till F ee P9t)LS Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 38/$GouwfEt (d. fig Ite Plan drawn to scale <br /> O �'7 and includes dimensions <br /> (C;ty.Slate Lip) (City,State,Zip) • <br /> 1" aasuu, COL S-3-718 ite Plan including location <br /> "ONE PHONE <br /> 1,6 ©- 2 22,^ 1 736 of well/septic <br /> E MAIL ADDRESS E- AILADDRESS Slti�rte.^,' <br /> ��f � '�� ,ti Setbacks Poo <br /> 'PROPERTY/LOCATION'INFORMATION ' (http://accessdane.ca.ciane.wi.us/) a Plan approval from '6'nc r eY <br /> PARENT PARCE NUMB R: /� ZONING' ACREAGE: <br /> D PNAURMCBEEIR 06 vl MIDI -v l<`' 4. 1 <br /> D 276 applicable township. <br /> TOWNSHIP. SECTION: <br /> 4014W Oe W/laSee. 2q ,/4: s C '/4V4: A 10 ural Address <br /> t DRESS (ne- <br /> V 2� MK�'�°� 6141/4.1 ca Flocs to scale <br /> CSM LOT BLOCK/LOT <br /> LuOL1 j"o(`bto Lot _11 Li Elev f property <br /> PROPOSED'PROJECT INFORMATION'':-...1 ''^!' fron a awn to scale. <br /> PROJECT DESCRIPTION: . <br /> • <br /> _T#J loocs)I.h� au)MtM114. i)c9Jt--' _ ❑ Dri permits <br /> . Li This pfroject is a new building or structure. (s unty,town) <br /> Li This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER ❑ Sa permits <br /> SEWER U SEPTIC (p IC, rivate) <br /> HEIGHT IN FEET r: R OF STORIES: (Not including basement) ❑ Wet Floodplain/ <br /> Sorel d (attachment) <br /> TO NEAREST SQUARE FOOT: <br /> (Outside dimensions includ'•- unfinished area, attached garages and above grade decks or porches) ❑ Er. on •ntrol permit <br /> BASEMENT 1ST FLOQ <br /> t✓ o 1' j TOTAL SQUARE FOOTAGE: ,, (s ope A isturbance, <br /> ftlll•sv-cce s) <br /> 2ND FLOOR 3RD FLOOR <br /> 14 0 01�eview Location <br /> ESTIMATED CONSTRUCTION COST: —. i —► ♦ ♦ ♦ $ 3 2 r d000.0 a and available options. <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? Cl Yes 2l No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes ❑No 21 Don't know <br /> 3. Have you talked with the township about your project? ❑Yes 'i No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. is a location survey required? BYes ❑No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes figNo <br /> APPLICATION MUST BE SIGNED <br /> - (Continue on Back) —► -+ —► <br /> 545-'f,iI-Ufii <br />