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e • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> U67—t-CS/,.4 Ls- f)-)/4-- 2 C r'�y /�,.i,r/A-L S/Ozz7c Zoning Status; CUP; C_ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ( Deed Restriction; CSM <br /> 702 VC - 6A '•v?L /7o /1 1 4-0.,S 4.'- w,S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> LLf7, . k© , /'-1 Site Plan drawn to scale JTJCSer• <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 234 3 <br /> AGENT NAME CONTRACTOR NAME <br /> (nt 6412fLf7 StdwS s/},.-I Site Plan including location 9//4 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ( 0 0 /2 v&'6 2 ltd ( )a) <br /> (City,State,Zip) se3.5s.) (City,State,Zip) Setbacks ► 2-3 3 �' <br /> 2cch L, J et-Q-A 4„.q_s <br /> PHONE PHONE ,Site Plan approval from ^/ 4 <br /> .6 of 6v 7.- a ca s)- applicable township. / <br /> E-MAIL ADDRESS E-MAIL ADDRESS �// <br /> i s, A-C A.►'1 )�Floor plans to scale 1 b ,�- <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) // <br /> PARENT PARCEL NUMBE CURRENTZON G: '2 ACREAGE: f Elevation of property yi‘ _` <br /> PARCEL /t�/ O_/ /�, frontage drawn to scale. <br /> TO SHIPER c� (� SE ION�c CI it �,( <br /> it V4 0 i '/.: c, '/a'/a:_S xi Driveway permit <br /> ADDRESS':L C/ /1 (state,coun town <br /> 70? 7 ' .D 4I�L 20 n'►' I SC) Sanitary •ermltS <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, 1 <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: f <br /> At 11-.0//4-- i ?, S , 2 ?J' L <br /> : <br /> 7 <br /> ❑ his project is a new building or structure. if /1 , g g , 3 <br /> This project is an addition/alteration to an existing building or structure. rr :- <br /> SANITARY SERVICE: PERMIT NUMBER: Z <br /> ❑SEWER <br /> XSEPTIC # ) S. <br /> HEIGHT IN FEET: .� a NUMBER OF STORIES: (Not including basement) 5, 1 <br /> AREA TO NEAREST SQUARE FOOT: ,` <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r. 'V,1 <br /> BASEMENT 1ST FLOOR: s>� � ��w� � <br /> i <br /> r 3 4, TOTAL SQUARE FOOTAGE: 4, « =" • T! <br /> 2ND FLOOR: 3RD FLOOR: /3 / 4 4• <br /> 1/0 <br /> �� 9Y Esrl; , <br /> ESTIMATED CONSTRUCTION COST: w • i"; ` <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ --► ♦ ? <br /> /J//�D//��Q , ,. - `a <br /> 3 t'O. O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ,"Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 'Yes C3 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Li Yes @ No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 14 Yes ❑No Z C8E.�_j—1:3 <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 4 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ,No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► <br />