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ZONING PERMIT APPLICATION www.countyofdane.com ;SUPPLEMENT to Web•App# <br /> PROPERTY OWNER; NFORMATION, '",' -1;;:.; !-- ' . At:� . _ -._ : _ :_ CU•TOMER TO PROVIDE <br /> R AME <br /> I�, r� �e� Zoning Status;CUP; <br /> OWNER ADDRE (Number,Stre't,Ci�v State,Zip) r De d Restriction;CSM <br /> 1L911 mole' Kc� 'ice ttls 535•3 1 V riance(# ) <br /> HOME PHONE CELL PHONE E- L ADD.U.SS I <br /> -87.3-69.85 . - 712.-7SOI o Q.V'e4-S 1 11 1/0•C-, CO Site Plan drawn to scale <br /> AGENT INFORMATION , .�: CONTRACTORJNFORMATION ' , : `nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> How E NON Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS �of well/septic <br /> (City,State,Zip) (City,State,Zip) t_I setbacks / <br /> PHONE PHONE • ❑ Site P approval from <br /> Icable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (hUp://accessdane.co.dane.wi.usi) :; Elevation of property <br /> PARENT PARC er <br /> NUMBER: CURRENTZO G: ACREAGE: p p y <br /> Li PARCEL 44/ sb� / -1? 9153 r frontage drawn to scale. <br /> NUMBER - I�0 �I"'�l'0.7U'�'�O �� �J <br /> TOWNSHIP: \ cc SECTION: . . <br /> 1eQSQh� J rtn s I a_ 1A: N. 1/1/: J'i J ❑ Zt-ievirtay-permits <br /> ADDRESS: County,town) <br /> Ita 17 kInden Ka 1t r eAc\. WS 5353 1 ❑ Santa :-"rmits <br /> CSM: LOT N A SUBDIVISION BLOCIULOT (p 0 ' private) <br /> PROPOSED PROJECT INFORMATION, . ` 0 �A � <br /> PROVECT DESCRIPTION: '11,1,-14, x : . a' , <br /> 14_, .�eS5or Y $ ` -, E x4 � <br /> this project is a new building or s cture P- o sf w w' <br /> ❑This project is an addition/alteration to an existing building or structure. ; ; . t <br /> SANITARY SERVICE: PERMIT NUMBER: a +- . <br /> ❑SEWER ❑SEPTIC ..--_,„,,4- 4 "9,t- I? VA <br /> :, 'w - ' <br /> HEIGHT IN FEET r I NUMBER OF STORIES: (Not including basement) ' � g �n '-, <br /> ask- 15 t(o one #>3 i9 m , t� . � <br /> � A�r -7,5 <br /> AREA TO NEAREST SQUARE FOOT: y �, �, �Y ,� <br /> is ', <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) I a . i @x <br /> BASEMENT 1ST FLOOR: �c,� �w ��� r S I . <br /> a� U I ) `, TOTAL SQUARE FOOTAGE: 9 <br /> 2ND FLOOR: N 4 3RD FLOOR: A sce Y s <! , :7,-.) ..,,,,A <br /> ESTIMATED CONSTRUCTION COST: .i�a®:I . i <br /> (Please round to nearest dollar) ..... �� IP k ,, � R ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ai es It ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Vi Yes into ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? G es Li No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Ci1lo <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 lllo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes lo <br /> .,...4. , ..---___ <br /> ' '' APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -+ <br /> 545-112(4/O8) <br />