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• <br /> ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web•App# <br /> w <br /> PROPERTY.OWNER.INFORMATION Z; _ z$_-' 1'V1O,4`=';1.1 ,..'-._: < 11- -= CUSTOMER TO PROVIDE <br /> O ER NAME 2— <br /> • Qh d( )C1)OFrLe`„u.r,fl Zonin Status;CUP; ,I <br /> 9 <br /> OWNER ADD ESS (Number,Street,City,State,Zip) /, , Deed Restriction;CSM ' <br /> //l /1/0r .-h . Md10�'YIan,-c_ �v, 537,O Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDORESS Ir_ <br /> Ok— ! q6_0/609 �4b'- 5-no- 4-156,9 Site Plan drawn to scale ce <br /> AGENT INFORMATION._::; ' CONTRACTOR INFORMATION _ nd includes dimensions <br /> AGENT NAME C911TRACT•R NME <br /> Ci)j a - /0•e"2-e_MG1.44.,,v 14. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> //l g. Nar-f-, S-6. &%o/'tV <br /> (City,State,z;p) (City,state,zip) Setbacks 4Ll a jr,rna LU t <br /> PHONE PONE Site Plan approval from k <br /> 1,6 '- lI al'S cj r`applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION '.:(http://acces.sdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT Z•NING: ACREAGE: X. <br /> \ P P rty <br /> LI PARCEL /� / frontage drawn to scale. <br /> NUMBER 0 va'I— `H-S-OO6.-v A- -i mo <br /> TOW SHIP: SECTION: <br /> rr i 31 1/4: N.E 1/4%: N� rAt Driveway per <br /> ADDRESS: (state,court .]`�/�� <br /> 5OLr 1,U• ! 2d to 3.S r1(t Yis by, .5j.'+�-2f XSanita •- •_ <br /> CSM: LOT J SUBDIVISI•N' BLOCK/LOT <br /> Cf� — / 4/ 4 (Publi• •rivate) <br /> PROPOSED PROJECT INFORMATION. <br /> > A a. • �` M — A.' , <br /> PROJECT DESCRIPTION: /I,e ) , ' <br /> -- .51 r►./e , et,s Er �`�� , <br /> f <br /> .his project is a new building or structure. 3� <br /> ❑This project is an addition/alteration to an existing building or structure. , >sx fi-ten y` t <br /> SANITARY SERVICE: PERMIT NUMBER: 1L A 3 ��"1°f`e a.('��X4�- <br /> D SEWER ■ PTIC c/ 'c T O r Pwa, t1--' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ' ix =" <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garage. and above grade decks or porches) )�� � ae .���, s� � � I � <br /> BASEMENT: 1ST FLOOR: tea^ t ■ <br /> /g -7 3617 l 4, TOTAL SQUARE FOOTAGE: � , • d 4" n a - <br /> ��, � <br /> 2ND FLOOR: 3RD FLOOR: ��� <br /> ESTIMATED CONSTRUCTION COST: '� <br /> Please round to nearest dollar <br /> 1. The property is within 300 feet of a stream or 1000 feel{ om a pond or lake? ❑Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property' ❑Yes � ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ....2<s ❑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 one) <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 /> (Continue on Back) —► —► —0. <br /> 545-112(4/08) <br />