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s/4 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION „.. _.,=_A., ,',-4 . ;, . ;; , r=._: r,:Pt-:� t. CUSTOMER TO PROVIDE <br /> OW NAME n /� _ <br /> I CC � E�f „� S ig Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> S S-7:.S 31 4. 4-4 Y ('c T 1 CSM <br /> Y 21 1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> YYr- P9 \ 575--(PP) <br /> jr4Site Plan drawn to scale <br /> AGENT INFORMATION I <br /> CONTRACTOR INFORMATION , and includes dimensions <br /> AGENT NAME // s CON CTOR NAME <br /> '4'1 t p Cer4A eic,.,26-.� `R. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS / of well/septic <br /> SOy Alietwsl vl pAIA' <br /> (City,State,Zip) (City,State,Zip) IA Setbacks <br /> PHONE PH 0.4A,tw -- Site an proval from•,V1 4 -5T(F 2-, e township: <br /> E-MAILADDRESS E-MAILADDRESS <br /> In-Floor plans to scale <br /> PROPERTY/LOCATION:INFORMATION is(http://accessdane.co.dane.wi.usl) <br /> PARENT PARCEL NUMBER: CURRENT NING: ACR E: - Elevation of property <br /> PARCEL BER Q.� 1` f✓1 Oi ,...341:73S- p �._ `7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: (,/ i'�r•Ve ermits <br /> frOe S,.w�, S� 1: cr. 1A1/4: <br /> ADDRESS: � F�� � 57' (Scat ,CO ty,town) <br /> CSM: 33 LOT SUBDIVISION BLOCK/LOT �. Sa ermits <br /> i/ tilt /, _ ( li private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DE CRIPTION: <br /> ��P' IIooX Co la& c 4 �. t <br /> W This project is a new building or structure. N :,, : <br /> Li This project is an addition/alteration to an existing building or structure. L= <br /> SANITARY SERVICE: PERMIT NUMBER: t7 t18° <br /> EWER SEPTIC fi- a .% , - <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ` ` 2- 3. p <br /> b <br /> 7 a kk ' <br /> AREA TO NEAREST SQUARE FOOT: � - <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' u ” <br /> BASEMENT: 1ST FLOOR: TZ* e °� ., :, <br /> 4, TOTAL SQUARE FOOTAGE: 4, , .„,ae L 6^:,_ <br /> 2ND FLOOR: 3RD FLOOR: � �-tI � <br /> / .1as_"C aor° Etc . <br /> ESTIMATED CONSTRUCTION COST: ' <br /> Please round to nearest dollar '♦ --► --► --► "+ "♦ /1 ■∎/l � � ���ifs <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li Yes i to Li 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 ❑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 with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Vlo ❑Don't know <br /> 7. Is this to correct a violation? Li Yes �JNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />