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- 3314 4 <br /> 'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> - PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> a.;on }' `K Mf0�C1 LtkrSol1 �,� <br /> l�'Zoning Status;CUP; <br /> OWNER ADDRESS (Numbbe�r,�Street,CityrSttat'e,Zip) J Deed Restriction; CSM <br /> yoo 5 C'lcvCAnc Variance # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Cray3(5''/6- 3.274/ E?5 Z-7392 , e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> ilia,41,111,/O ; ,,I loWner ite Plan including location <br /> AGENT ADDRESS CONTRACTO- '..' S of well/se tic <br /> (City,State,Zip) (City,State,Zip) �, etbacks <br /> PHONE PHONE l+d'Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS d <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: ,,,. CURRENTZ ING: ACREAGE: . ='ation of property <br /> 0 PARCEL !! '' �� � e J l l rontase drawn to scale. <br /> NUMBER 0,(o t a I -293-OS 7-C <br /> TOWNSHIP: ,/ / SECTION: 1 1 1 i II veway pe •:;.� <br /> V�� S /4: 44/4: 1 <br /> ADDRE - - - coun ,town <br /> j In o 1 P N�3 L !, a <br /> CSM: LOT SUB ISION BLOCK/LOT " S- ary permits <br /> Viikso, e,l�� _ (public,private) <br /> PROPOSED PROJECT INFORMATION *kSTAFF REVIEW <br /> PROJECT DESCRIPTION: / ,/{ 5n9 <br /> yew( e- Ii Ing District <br /> ®This project is a new building or structure. errnitted Use?A <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Aim— ❑, I Address <br /> ©SEWER ❑SEPTIC &COO n'e ' xlstin ) ° <br /> HEIGHT IN FEET i 1 NUMBER OF STO ES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: Shorelarid (attaGt 1p997 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ° <br /> BASEMENT: 7/ 1ST FLOOR: rosltinGontrolperrr>Its <br /> �/ / v I/ I�S TOTAL SQUARE FOOTAGE: ,, (slopes`,disturbance, <br /> fmin: � ss w,.!,, <br /> 2ND FLOOR: 5c) 3RD FLOOR: eQ39 `7(� <br /> lJ° / `1 A e I,cCetic 3Sunley , <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ ♦ ♦ - Q , Ud , and +aonS <br /> (Please round to nearest dollar) $ G� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes l� 1 o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes U. lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? -.- g<s UN() <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes l�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) es U No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 12<z No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4108) <br />