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;SUPPLEMENT to Web App;# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY;OWNER 11FORMATION 1t;r�,-i„; i_��,,-, r 1�a4 :4i..-,.;_4 ; CUSTOMER TO PROVIDE <br /> 0 'AME ! / • <br /> ` ' 1 n Zoning Status; CUP; <br /> OWNER ADDRESS Num.- treet,City,Stat- Zip) <br /> Q � /, �, � � �/— .--.5�',"7 Deed Restriction; CSM <br /> �E��U !/v • Variance(# 5c•- afOW <br /> H M HONE r LL PHO E E-MAIL ADDRESS . <br /> :ot v/ n Site Plan drawn to scale <br /> AGENT=INF OR nAAT1O0 n_?` �' ",tint; rci NTItACTO�t INFOR 1gT10N -` t _ and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S�-IN. `e , /9_iA„, n Site Plan including locatipn <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic �/' <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ['Site P ,,. •rival from <br /> appli : •, nship. <br /> E-MAILADDRESS E-MAILADDRESS . <br /> El Floor plans to scale <br /> :PROPERTY/LOCATION INFORI)AAtIOMr-:(httpJ/'acces bane co,dane:viri.us/)� µ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: n - • SECTION: <br /> S Q -t 2L 5- %4: '/4'/4: 0 Driveway permits a <br /> J (state,county,town) <br /> b-19 5. fry er <br /> 5' r7c� 14 /J L'rt�-`/� - fig--- - - 3`l <br /> Q Sanitary permits <br /> CSM: �L T SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT_INFORMATION <br /> PROJECT DESCRIPTIO SZt~ Rte'74, <br /> �� yi,vetAA„ <br /> th7 - i�t i 72 3 W ' <br /> This projd'ct is a new buildin or structure. `4' <br /> k I seed sue, <br /> This project is an addition/alteration to an existing building or structure. , 1. = -� <br /> L. - <br /> SANITARY SERVICE PERMITNUMBER: , - ••, 5 ! _p" <br /> x <br /> EWER 1XIEPTIC %_� . _� '';, L t - <br /> HEI HT IN FEET: i NUMBER OF STORIES; (Not including basement) ��3 <br /> i � e I •t Ogle• l "' <br /> tip a BI V <br /> AREA TO NEAREST SQUARE FOOT: .s4 <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) is`''" _ � r _ - <br /> BASEMENT: 1ST FLOOR: 4 7 0 Pt,A' - •' A.'� <br /> 9 ✓ v`- L{ 2 I - j TOTAL SQUARE FOOTAGE: + `1 y3? r'-04... t°� "4••2ND FLOOR: 3RD FLOOR: 1 / rA` ° '� - g}_,t'_ <br /> If/ i --ter ", <br /> ESTIMATED CONSTRUCTION COST . <br /> (Please round to nearest dollar) ♦ -* ♦ -4. $ 1 f 5 OCd - r ,;.� ,e.1�. <br /> z d� , <br /> a c -. No - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? lad es QNo.- ❑Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? 1'es ENo .['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 11,%7-s ❑No. _ <br /> �� <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0Yes • i o . . . <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i none) <br /> 6. Is a location survey required? (see reverse) - 7 C,it r rt `'hi..... '/ ',? ❑Yes o . ❑Don't know <br /> 7. Is this to correct a violation? - ❑Yes o <br /> • <br /> • &46.r r -- . APPLICATION MUST BE SIGNED <br /> • (Continue on Back) -9 - -+ <br /> 545-112 4ro8) 2 5,-d . .26 . <br />