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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWLER NAME I <br /> t r' a� - 1 - c ¶ ' , Q. \ \ \"* rKC oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ll Deed Restriction; CSM <br /> \, 4 t�S ak�O��s :.� '�_ ,eta LL)i..c K 55 l Variance(# ) <br /> `► HOME PHONE CELL PHONE E-MAIL/` R_ESS <br /> Co� `{-SSS+hoe-239-930to h`�‘r'�S @ cYr.` "k •�Oi^^ ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incl des dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location <br /> AGENT ADDRESS CONTRACTOR AD.- -. of eptic <br /> (City,State,Zip) (City,State,Zip) cks <br /> PHONE PHONE — Site n proval from <br /> a township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floo plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: of 0 Q - 0 CURRENT ZONI G. ACREAGE: P P y <br /> ❑ Nu BER 0T(1%(o(-C1 2. A 2.��� 2-3 frontage drawn to scale. <br /> TOWNSHIP: SECTIO : ,J ❑ Dfl a rmits <br /> bl°�\T1L°� �� 1/4: 1414: " (stet O ty,town) <br /> ADDRESS: � , ` <br /> 4 t-•-S O tc‘. r'-, -- oc► , <br /> CSM: LOT LOCK/LOT anita _•- •.'s <br /> 0 "-7 aq, 3 (pus ' ,private)- <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: S <br /> FF RE /IEW <br /> , <br /> �'i o x t o -3 S so., �1": co"... D - <br /> 2 v� r orclr. on District < <br /> ❑This project is a new building or structure. errnitted Use? <br /> This project is an addition/alteration to an existing building or structure. A <br /> SANITARY SERVICE: PERMIT NUMBER: rai As s s <br /> ❑SEWER IN SEPTIC 20 g4•44 Z Q o -i 3-o ep5-2 <br /> , (ne existt <br /> HEIGHT IN FEET: /S ( J NUMBER OF STORIES: (Not including basement) <br /> 2 et oodpIa,N <br /> Sho (attachrrtent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: f rpsion s[pegnit A <br /> p O I x l O r 4, TOTAL SQUARE FOOTAGE: 4, , slopes, '�- , <br /> 1 filling/ «c:- ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 101x (0' 2C0 s9 -. <br /> fievle, r.to Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ) and av � =leoptions. <br /> (Please round to nearest dollar) I ('�V0 CSO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes lea No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? El Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes No <br /> %5. Is this project associated wither rezorje/CUP/variance(petition/appeal# ) (leave,blank if none) <br /> 6. Is a location survey required? (see reverse) 0 Yes JA No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes El No <br /> ICI MUST B- IGE <br /> (Continue APPLAT on ON Back) ♦E S. N E. <br /> 545-112(4/08) <br />