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• <br /> (E' t(. -1--ct5 -t- 181 <br /> 'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION U • u ER TO PROVIDE <br /> OWNER NAME I o01 --�— <br /> \T.;Jam/ ,et�H erZe°F... 3 Zoning Sta us; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4-700 ge726f¢rwv.--7' ' ' • , 7(4,0 , Gam/ f3562- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME <br /> Al...1-RACTOR NA E_�, „f,�, Alc oBcG,I"/htji -s /�&• La-Site Plan including location 1 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Tq2 3 rib 2P44-7-- /6. V <br /> (City,State,Zip) (City,State,Zip) L-Setbacks <br /> /1 iaDi-C--7b.- (A// 373l6Z- <br /> PHONE PHONE IA-Site Plan approval from . I'/_ <br /> -'3/-- �¢L2, applicable township. V 1 <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> \j/ce.41,024"="j&4 E1/41040LMi'/Zorfr1.come 1�l o <br /> or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAC --� cievation of property <br /> %PARCEL Mpg_ 3 _ fogs- / —/.� / �. �J frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: c IA-Driveway perrnitS <br /> Sf,G.�6t �� 1/4'/ 1/41/4: �� (state,county,town) <br /> ADDRESS: //�� <br /> '4' Atie 1Z-- Sanitary permits / <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) �/ <br /> /Z-47th <br /> PROPOSED PROJECT INFORMATION 1 <br /> PROJECT DESCRIPTION: <br /> NFw i 7 -' LE -gi / sire e3ice —/IL."`6 ❑ Zoning District 5 <br /> . ►4 This project is a new building or structure. Permitted Use? V <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ n!” Address r <br /> tiew/ istin s t h(l <br /> ❑SEWER SEPTIC SZa�gZ g� <br /> 8F <br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) <br /> '2 S 2 f t—iCPOS i s !eanz F <br /> loop n k <br /> Shorelarid chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ OtidttG ntrO permit; <br /> BASEMENT: 1ST FLOOR: <br /> 2-90 L /� 4. TOTAL SQUARE FOOTAGE: ,, (Slopes,,disturbance r <br /> - filling/access) Ap <br /> 2ND FLOOR: Z-3/ 3RD FLOOR: iyit /0 <br /> / Iri .eview Location,Survey <br /> ESTIMATED CONSTRUCTION COST: -nd avallablre*-0-- <br /> (Please round to nearest dollar) -i - - -0 - -► $ bb�j �0 , ail ... . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes Colo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ©'N° ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0lo <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) ❑Yes 0'No ❑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(4/0B) <br />