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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#- <br /> PROPERTY.OWNER:.INFORMATION,." _ _ ' '-f 3 '.;la;,, z. .._t .t ?- CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 54T v'E hack 12 5 vobod ;- Zoning Status;CUP; �' <br /> OWNER ADDRESS,( umbe,$treet,City,State,Zip) Deed Restriction;CSM <br /> ,35© l 14-1 61/1 ; Scow Prcorle wZ S 3JSb Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS j <br /> $3L/ . /-7(09 t4 Site Plan drawn to scale j ^ 90 <br /> AGENT INFORMATION>;::' .,! CONTRACTOR;INFORMATION'-? and includes dimensions <br /> AGENT NAME CONTRACTOR NAME • 1;I , (. r. ,� <br /> Archart Ck- of ds Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> a evo�ress Or /ab _ _. 7 0/3 0/S 0 /v <br /> (City,State,Zip) (City,W)te,Zip) Setbacks <br /> * L751/0 v-F vZ S 3S-67 <br /> PHONE PHONE " l Site Plan approval fro A <br /> - ( pi5 ) i5 3q -'/133 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> orythack,V--@ Qv J c 0 Floor plans to scale <br /> PROPERTY/LOCATION:INFORMATION ':;(http:l/accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: �'4 Elevation of property <br /> D PARCEL frontage drawn to scale. ' <br /> NUMBER <br /> TOWNSHIP: SECTION: Af . <br /> ,/: ,/,/. Of Driveway permi /O • <br /> ADDRESS: //� (state,coun <br /> �j0( 1.rlT 614 CO0ri--‘ SUbL. evy,rKl£'t��t: <br /> 0 (P Sanitary p .. /�/ <br /> CSM: LOT SUBDIVISION B OCK/LOT ublic i / I/ <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> re te.t.k_ Gu rre,&f r v c i e -6 ac c kuto &-aI rSAi .i <br /> ❑This project is a new building or structure. �:p -yy py' <br /> fig: �A� F�,A''°i.Y t"3'�" <br /> ,This project is an addition/alteration to an existing building or structure. ' $•1 m� 6rvq <br /> SANITARY SERVICE: PERMIT NUMBER: � � � g �°° -.,� � � � ,/� <br /> ❑SEWER ❑SEPTIC 4�' - j /yam <br /> i# t <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) i :'.1 / <br /> AREA TO NEAREST SQUARE FOOT: P.'5,--41:i7;-;\ K <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , " :, rte <br /> BASEMENT: 1ST FLOOR: : ®1<.i '!::,t.., : °� 4 A <br /> 4 TOTAL SQUARE FOOTAGE: ,!,..'-!,..!;,1' <br /> w.:00:=� 31, : '�4 <br /> 4 <br /> 2ND FLOOR: 3RD FLOOR: �� <br /> or° - Y- <br /> ESTIMATED CONSTRUCTION COST /� <br /> (Please round to nearest dollar) �� / �3 sf.c, r c. l. <br /> :. ' ?ot 60 <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 ❑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 /> (Continue on Back) —► —► -* <br /> 545-112(4/08) <br />