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V <br /> :SUPPLEMENT-toWeb•App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION ,;; z.f ._' �V,W�1,1,.X::;? .., t'-?•= % CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> J0 Co n Q tif .Zoning Status;CUP; <br /> OWNER ADDRESS tkie(Number,Street,City,State,Zip) Deed Restriction;CSM <br /> HOME 1 CELL 132 .. 5/Du Ektoh, COI , S3S ? 7 Variance(# ) <br /> ,08— g73-8800 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR:;INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Oa c1, d ever e ft Cl Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> SP+ Tower Or. <br /> (City,State,Zip) (City,State,Zip) CI Setbacks <br /> 51.7.)Lt del Vil 3-35-e7 <br /> PHONE PHONE 1 / ) ❑ Site Plan approval from <br /> ‘ O8- -8'73 — (s3 7 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION+.:(http://accessdane.co danewi.us/) ❑ Elevation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> ❑ PARCEL I9106 frontage drawn to scale. <br /> NUMBER b51 l- Ot,�-! -`i'3 y I - I C- Z p,z-14-1 <br /> TOWNSHIP: SECTI N: ❑ DfIVeWa <br /> 04n Kirf 1/4: 1"4 4: ypermits <br /> ADDRESS: (state,county,town) <br /> t3 2 ►x5 1-tt,.-`r 5i i 3 t> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION; i + .. '." 44 <br /> PROJECT DESCRIPTION: }'141- r a <br /> STDCU. � ilt. t'T� -c 4Lrrb 2€SPlhi2 f",4--4,- -!.1,NI.3..4,1..e.1-.' s`z N '_ <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: PERMIT NUMBER: .k� P <br /> - <br /> '❑SEWER I EPTIC a 3 a <br /> ` ," <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '' ' <br /> I ,.„,,,,,, 1,14,,,, .-i". er ; ; <br /> �F 9F6& b59 5t14,7-mss. <br /> AREA TO NEAREST SQUARE FOOT s <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) g k <br /> BASEMENT: 1 ST FLOOR: ® ®��4414.9 1 r �� :- <br /> tZOC: TOTAL SQUARE FOOTAGE: t. ,,I`-t i' �(1 i & a� <br /> 2ND FLOOR: 3RD FLOOR: <br /> a xt° islt bEilgt . <br /> ESTIMATED CONSTRUCTION COST ' , I e g <br /> �Si �(Please round to nearest dollar) t _ � ig <br /> %:^:t <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 No ❑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 ONo <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) SYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes $No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -I► -* -* <br /> 545-112(4/08) <br />