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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 /> 5041 N 3A'b° ❑ Zoning Sta ;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed striction; CSM <br /> ) 7©5 WaS i rt/retbN .. T, N)rt; YogetY w- S3572- ari nce(# ) <br /> OME PHONE CELL PHONE E-MAIL ADDRESS <br /> 08 64?-3584 669— 6779 ISi Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S' Plan including location <br /> AGENT ADDRESS (� CONTRAOTOR ADDRESS well/septic <br /> (City,State,Zip) <br /> O �f (City,State,Zip) Li Setbacks <br /> PHONE PHONE ❑ Site Plan royal from <br /> appli a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor p s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: a CURRENT ZONING: ACREAGE:... . <br /> ❑ NUMBER Q(of7'T- 3'13- (a"(S--0 e--z .1k4` frontage drawn to scale. <br /> TOWNSHIP: SECTIlti <br /> 1,j <br /> SP2tN�DALE Y4: S w 1�41A: ❑ Drivew ermits <br /> 5-3s-7 (st ,county,town) <br /> ADDRESS: <br /> i o S WK f, v�.t1+b Sv. Ayr; " , ,./�- <br /> 2- <br /> ❑ Sanita mits <br /> CSM: LOT S J1 6DIylg14 ..n 0 BLOCK/LOT (pu ' ,private) <br /> /3 <br /> 4,IN VveA K'S '• 1 2-7 6 <br /> PROPOSED PROJECT INFORMATION TAP[i REV W <br /> PROJECT DESCRIPTION: <br /> _ <br /> e4w 4 -- <br /> /'V� <br /> v 4ning District ; 4 <br /> • 21 This project is a new building or structure. Permitted sk ttU <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural 'd°• <br /> ❑SEWER PEPTIC (new/ Ong) 4Pr Y <br /> HEIGHT IN FEET j IC) NUMBER O'STORIES: (Not including basement)i ❑ 1/lletlandflo In/ <br /> Shor attacktmen <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r � �COS)OnC?43nt Ka • rmat 3a 0 <br /> 1 TOTAL SQUARE FOOTAGE: ,, (slop tf rbanCe � <br /> fi(fl0® aegeS20 N <br /> 2ND FLOOR: 3RD FLOOR: /O ! :: , <br /> 'Peview Locatiot Surve 3 <br /> ESTIMATED CONSTRUCTION COST: $ / � ©o X31 and 8.yalra?Ce p(}tIOnS <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ �J LJ 51-4 e x,„ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes T No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes gi No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? CilYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Xi No <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) -; .- •_ •• e) vologt <br /> 6. Is a location survey required? (see reverse) n Yes ❑No A Don't know <br /> 7. Is this to correct a violation? ❑Yes ►' No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />