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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER`.INFORMATION` ,, _ z ; _'1411.14'14:01;: ,.,; ., r y CUSTOMER TO PROVIDE <br /> OWNER AME <br /> r ? ' Jv is i vs <br /> r� S /►l Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction;CSM <br /> -1 °10 Lvi/v Q) ( f"pL�1-04 lA S n Variance(# ) <br /> (665(665 a).3-3 1 CELL PHONE E-MAIL ADDRESS <br /> a)3`3 L 1 4 .''� 1 • LS f-T 0 4' 4f+ rid- ❑ Site Plan drawn to scale <br /> AGENT INFORMATION._::, , - CONTRACTOR INFORMATION 2 , • ,, i and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Shy\ (ri„L, ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS J of well/septic <br /> (City,State,Zip) (C' State,Zip) full Setbacks 701 1)/ ) II V <br /> (CA S 5c SS <br /> PHONE PHONE K&Site Plan approval from, A__ <br /> (60,E)) 3 33- z-,°)9-1 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> XFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:1/accessdane:co.dane.wi.usn . <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: �'A Elevation of property <br /> ❑ PARCEL et /1-33),_5y0S_0 L�cb v- frontage drawn to scale. <br /> NUMBER <br /> TO SHIP: SECTION: <br /> e v-�- Snir),� 1/: %IA: Driveway permi <br /> ADDRESS: �" (state,county ar <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION, TA-' _, tPROJECT DESCRIPTION: r,a- , <br /> 6 e-64 3 / X I dafirIMBILMF ' <br /> 9 @ q &4rn)'9 � k <br /> ❑This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. - <br /> SANITARY SERVICE: rijiil s?" K1." <br /> PERMIT NUMBER: �h. �. <br /> ❑SEWER ' EPTIC �`' I^` '.; <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ",-., , $LOO ,f o <br /> ptoreini <br /> ti fV <br /> AREA TO NEAREST SQUARE FOOT: e� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,-1 .,...„'4 1 <br /> BASEMENT 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4, ` t ,, � ,74 z!, 4 >.31 <br /> 2ND FLOOR: 3RD FLOOR: - pf ¢" + i i '� <br /> • .STRUCTION COST: iL F® g�qse round to n-crest dollar) � (%Q �� u . <br /> 1. The . •.erty is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes L` No ❑Don't know <br /> . s there a wetland or floodplain on or near the property? ❑Yes Lallo ❑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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -+ -I. -.1. <br />