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3 3. ,pi <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION ., ,.. CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Y -t01A-P ? iCYYV2O i- LC 01 oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,Ci ,State,Zip) Deed Restriction;CSM <br /> (p gt7 l S Tb wive , ( 1 l.or. 33113 Variance(# ) <br /> H•ME PHONE CELL PHONE E-MAIL ADDRESS <br /> • di -�-afe 319 r Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG T AME CONTRACTOR NAME <br /> ?crn ��` VDU Site 1316 including location . <br /> AG TADDRESS \ CONTRACTOR ADDRESS Of ell/septic <br /> (City,State,Zip) (City,State,Zip) ` <br /> Setbacks <br /> PHONE PHONE 'I.�it n approval from <br /> pl ble township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 101 loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danewLusi) �� levation of property <br /> PARENT PARCEL NUMBER: CURRE�q ZO NG: ACREAGE: <br /> 0 NUMBER ©`1\O 2 o 3 Oil Fs a• /(-3 , a).S frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> O ' ' ' ��' .Drive y permits <br /> �l�i h�Sot/ �`�' (s e,county,town) <br /> ADDRESS: <br /> ��3-Z1 Q m br @'�an' -• permits <br /> CSM: LT 5C)-- SUBDIVISION BLOCK/LOT <br /> bli ,private) <br /> MY* •J M e-1015 4116 <br /> PROPOSED PROJECT INFORMATION `' 3 - `1 'i ° ;' :4 <br /> PROJECT DESCRIPTION: ' <br /> . This project is a new building or structure. 1.4 ; ;',,t : 1 <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 4-�- a )�(t aS�'lg f�'_ <br /> EWER ❑SEPTIC <br /> HEIGHT IN FEET I NUMBER OF STORIES; (Not including basement) i <br /> ;,j,t.)r i-ha s ,r-to . i. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,,E3 4 0,140. i <br /> BASEMENT 1ST FLOOR: <br /> /� / <br /> )1 / / V � 4, TOTAL SQUARE FOOTAGE: j ( I4,i'=4?:3Il°Pi»p°1au <br /> 2 FLOOR: 3RD FLOOR: J a r ',341[1,11 01 4 �, <br /> .,,(� t a�w e r J ! <br /> ESTIMATED CONSTRUCTION COST: ♦ -i ♦ ♦ ♦ -► Q 0I0,i ,�ffitz.pi c»)0,11-i0.--,, i <br /> (Please round to nearest dollar) $ / / �� QQ• O� ,22L,"-=-:1,21.---2,..-.1 ;: <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0 Yes lid No 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes (ld No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes f}No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Jlo <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) TAYes 0 No 0 Don't know <br /> 7. Is this to correct a violation? 0 Yes ( ]No <br /> APPLICATION MU BE SIGNED <br /> (Continue on BackST) -* -► -► <br /> 545-112(4/08) <br />