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. 'i- /7-St) - S S <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY.OWNER;:INFORMATION° .z=_;:, ','X :X 3l. ,r; * l"` CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> M Ai-V '`) 4-°". Q Zonin Status;CUP; <br /> OWNERADORESS (Numbef,Street,�city tate,Zip) g ' <br /> rt7 J eed Restriction;CSM <br /> A , --- (3&Jrns v, / M ' ' .,5 )) <br /> � � Variance(# ) <br /> HOME PHONE CELL P ONE - ADDRESS <br /> I'Dr 837-51 *' = Site Plan drawn to scale <br /> AGENT IriFor. :annn _ I CONTRLCTOR:;INFORMATION ' -; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> .Tr t/6,/ r4tsc44 _____ AO v, 16 1.0G <br /> Ceof ►' Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ,,) a sep' ^, <br /> eS�bl Vx w act-g- '( 1°)0A' rJ�-K(9 I <br /> (City,State,Zi (City,State,Zip) Setbacks e <br /> �iu0$`-1" j�U)S c3S3 Z j�O�� wl5 '53s °l3 .� ��„" CCC <br /> PHONE / J PHONE Site PI approval from <br /> 60 f—6-z, /6.2 I 60(r-,;133 --o o 0 a cable township: <br /> E-MAIL ADDRESS /- E-MAIL ADDRESS <br /> $k;4tsc , �dto�/161d�G>1e . ,. office, IA(f, • •CI,M. _ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usa Elevation of roP e rtY <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P <br /> ❑ PARCEL C_ frontage drawn to scale. <br /> NUMBER ©`5 to �'y 3$S n a q S ci � <br /> TOWNSHIP: SECTION: <br /> �-!r ,/: S� 1/41/4: N t 1g Drive ay rmits <br /> ` (state unty,town) <br /> ADDRESS: Mme. N� I <br /> S 3�� eP` ani -• .ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT pu• ' , •rivate):1-/ <br /> i � ��Y-- <br /> PROPOSED PROJECT INFORMATION; - <br /> PROJECT DESCRIPTION: I \' / 's 4 z' <br /> c <br /> ❑This project is a new building or structure. �� <br /> l i(This project is an addition/alteration to an existing building or structure. ;` ,'; <br /> 7,;7 ;5 F M1 _ r'''' 5�£ <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑SEWER 0 SEPTIC 11 C) *�"�:, 1 , e <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> . :,1 a 9lt .a ti�ka $ F"r:u,4 <br /> ,1 "� 4 �M <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � '` <br /> BASEMENT: 1ST FLOOR: ®������ <br /> p� S 4, TOTAL SQUARE FOOTAGE: r:*, ;'• ' t t _,( � �A <br /> ,g �s <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: bo c. _21 I. <br /> (Please round to nearest dollar) --► .4 � .4 -4 $ /75,0� - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes — N0 ❑o on't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EitiNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes iitNo <br /> 5. Is this project associated with : rezUP/variance(petition/appeal#9°12-1 ) (leave blank if none) Off- <br /> 6. Is a location survey required? (see reverse) CI Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -i <br /> 545.112(4/08) <br />