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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 /> Nick- we be v. <br /> OWNERADDRES (Nv tuber,�s tr�City,State,Zip) 1=1 Zoning Status;CUP; <br /> ZOZ �d-t I V✓. ma.rske.I k 1 I S.-31-5-41 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL A'DRESS <br /> Z19—1'38'1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION: and includes dimensions <br /> AGENT NAME CONTRA'TOR NAME <br /> S,`,w`� S f"iorl1 or.. Ravi.,PS ❑ Site Plan including location <br /> AGENT ADDRESS CONTRA¢TOR ADDRESS of well/septic <br /> (a (o, C.4.1-4-4_,c C 1. <br /> (City,State,Zip) (City,Stat ,Zip) ❑ Setbacks <br /> Co-Hc.Tr 61.ov-e • <br /> PHONE PHONE ❑ Site Plan approval from <br /> &°r- 402.0 -3 rZ.I'• applicable township. <br /> E-MAIL ADDRESS E-MAIL•'DRESS . <br /> Hvrl ••11 El 0.144.e 5 001 .7 j 4^'1‘ ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) : ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: <br /> ❑ PARCEL oz t/obf 0-1 VT-2x.'16- tZ ( .1413 frontage drawn to scale. <br /> NUMBER <br /> TO SECTION1 <br /> lo'Wh .Oe tvKt 1 1/: 1/1/: El Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2 yTo We.ti beset !t U . rea( <br /> CSM: LOT Nark; ON BLOCK/LOT ❑ Sanitary permits <br /> ,Z �♦„ ,rs.t� (public,private)toP „.e hIS <br /> PROPOSED PROJECT INFORMATION * :-. <br /> PROJECT DESCRIPTION: 4 ,� <br /> --� �l4 laxca I Yeti ov�c� �1� qi3; =tae,. <br /> IS This project is a new building or structure. 5 A€g fr ioP:)�_ _) <br /> ❑This project is an addition/alteration to an existins building or structure. <br /> SANITARY SERVICE: PERMIT N MBER: • 1 kYwCf, <br /> VISEWER nSEPTIC , z' 0W '' -i 1.0 - A <br /> fi° <br /> HEIGHT IN FEET NUMBER e F STORIES: (Not Including basement) s - s t' <br /> AREA TO NEAREST SQUA"E FOOT: .. f <br /> (Outside dimensions including unfinished area attached 'a -ges and above grade decks or porches) fa ,?i � _ 1 <br /> BASEMEN 1ST FLOOR: f <br /> V I TOTAL SQUARE FOOTAGE: j t i ..* -'r°- -V. 4 '3 <br /> 2ND FLOOR: 3RD FLOOR: n LI <br /> r--- V I f � - __ <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ -0- 5- c}z�Zlr ohTg '_ <br /> (Please round to nearest dollar) <br /> y/ 0d a <br /> 1. The property is within 300 feet of a stream or 100 feet from a pond or lake? ❑Yes ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the prop rty? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your proj Ct and are they in agreement? Yes . No • <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? El Yes ®No <br /> 5. Is this project associated with a rezone/CUP/varia ce (petition/appeal# ) (leave blank if none) . <br /> 6. Is a location survey required? (see reverse) ❑Yes El No ©Don't know <br /> 7. Is this to correct a violation? i ❑Yes No <br /> �I <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i =■ -► <br /> 545-112(4/08) <br />