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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 /> C T + Ar►' fir" Q'—d• S° ❑ Zoning tus; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ee estriction; CSM <br /> 19 5-(0 � 1�^1 4 ance(# ) <br /> HOME PHONE ELL PHONE EMAIL DRESS <br /> Q,73 c> 4 8 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> TAM MATSocJ rn ! erN,:1 4 c.,j3R-cn 440^^.46:4 S. a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> -p. .'fix - %. .�.r-- . 'S op*Y+e._,. <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE Saw PHONE to PI ,..... ••royal from <br /> Co08— 8'73—437 O0 e township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 4 I - .�e►M - oi`, 4:00-1 loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) / Elevation of property <br /> PARENT PARCEL NUMBER: / 1 .J�CURR�RENTZONING: ACREAGE: p p y <br /> ❑ NUMBER vC `1 '' /// ,,8�1� v A Z. C 8) j Stl — frontage drawn to scale. t <br /> TOWNSHIP: SECTION: (1 4.,‘ <br /> �Rt` <br /> ?t �S o,v, *A--; �. S . 1/a: 141/a: ❑ Driveway permits Kt <br /> e tate,county,town) <br /> ADDRESS: <br /> I fbs �r <br /> O KG4t.ko h 0,h 'S - I Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pu• Ic,private) <br /> PROPOSED PROJECT INFORMATION : S AFB REVIEW i <br /> PRO CT DESCRIPTION: c <br /> `` i1N ( • a c C - a Ing District <br /> . ■ This project is a new building or structure. ❑ ermitted Use? <br /> ❑This project is an addition/ Iteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: A ❑ Rural A°. k <br /> ❑SEWER PTIC l (new/ l rn+ .' <br /> 6 /1 <br /> HEIGHT IN FEET 17 t NUMBER OF STORIES: (Not including basement) <br /> ❑ U1letlartcflFfao of <br /> Shoreia attaetrmeri <br /> AREA TO NEAREST SQUARE FOOT: t:' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> Q rosionDontr erm)t� <br /> BASEMENT: 1ST FLOOR: f r <br /> / 0L(y(3 TOTAL SQUARE FOOTAGE: y (SIOpeSr r Cer ' <br /> 1/ fltttn ceess <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review , attori Surrey <br /> ESTIMATED CONSTRUCTION COST: $ �^ )0 and gable options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ V <br /> / �? <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes El Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes o <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 with a rezone/CUP/variance (petition/appeal# ) (leave blan if one) <br /> 6. Is a location survey required? (see reverse) ❑Yes o El Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* —► —* <br /> 545-112(4/08) <br />