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-3-3 S a?)-7. ,S .?:: -2- )r ..? --74- S 0 ------- ■ II <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION ` . '.;Y,, ' CUSTOMER TO PROVIDE <br /> OW ER NAME <br /> OW ER DDRE S (Number,Street,City,State,Zip) <br /> t`E l Zoning Status;CUP;' O <br /> _ Deed Restriction;CSM 9n <br /> c Z1 1 IAA • t P_-c.H -.11r-- • -.. ' ------ -A). --. at 53S0g Variance # <br /> HOME PHONE CELL PHONE E-MAIL ADORE•S ( )L S ' <br /> o <br /> , :•7' J(�$770• ■,,,bC �i�OLd-Ls-)P -c o"A CO Site Plan drawn to scale `"�/ <br /> AGENT INFORMATION ;.I CONTRACTOR INFORMATION _ �-, and includes dimensions nr 0f�s <br /> AGENT NAME CONTRACTOR NAME <br /> 'lK... 1s -M up,t.. C„p . Site Plan including location <br /> AGENTA RESS CONTRACTOR *DRESS of well/septic <br /> I?-A4 I L twtt. 5-r. <br /> (City,State,Zip) (City,State,Zip) . rr Setbacks <br /> (M Apt - 1.Jt 53-14`_ <br /> PHONE PHONE .Site ap val from <br /> (0o5 • E,S"� , Z2ct applicab nship: <br /> E-MAIL AD ESS E ILADDRE- <br /> o{s\0 i, $4,F,v.r ,ups •c. A door plans to scale <br /> PROPERTY/LOCATION INFORMATION :(http://accessdane.co.dane.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CU ENT 4jONI G: ACREAGE: P P rty <br /> ❑ NUMBER 0707.27 31790•D 7 - 1-c t/3 pc-e • +/_ frontage drawn to scale. <br /> T NSHIP: SECTION:. <br /> P.o: �i..c.►t.�s Z•7 1/4: 5\4 1/41/4: 5 E Drive p its <br /> ADDRESS: I (Sta e, ty,town) <br /> y 152 C,c•V„7C-c 4\t, t"..,P ( Sanity its <br /> CSM: LOT SUBDIVISION BLOCK/LOT U • , • ate) <br /> .....■.416.41I. <br /> PROPOSED PROJECT INFORMATION <br /> --• ECT DESCRIPTION: <br /> �2-Ato l? •1dPfl 1'TtOti1 = !:i..s =��-1, ►_'yL I. <br /> ❑This project is a new building or structure. , r <br /> YEThis project is an addition/alteration to an existing bull*ing or structure. t <br /> SANITARY SERVICE: PERMIT/JAMB - B' <br /> ❑SEWER SEPTIC IV /...clli 1 i <br /> HEIGHT IN FEET: NUMBER OF ST•RIES•,(l it including basement) . <br /> 1 <br /> AREA TO NEAREST SQUARE FO•T <br /> (Outside dimensions including unfinished area,attached garages -nd above grade decks or porches) [ y <br /> BASEMENT 1 ST FL OR: <br /> 1 i � 1 4,TOTAL SQUARE FOOTAGE 4, T , , <br /> E� <br /> 2ND FL OR: 3R LOOR: :4:s_S <br /> ESTI TED CONSTRUCTION COST: <br /> (Please round to nearest dollar) $ A01000 �_ I � �� � <br /> ♦ ♦ ♦ -► ` <br /> I <br /> _ y <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 p Don't know <br /> 3. Have you talked with the township about your project and are they in agreement?..- f Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ... ❑Yes 1:81 No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le ve 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 gNo <br /> APPLICATION S B► E <br /> (Continue on BacMUk)T -E SIGN-* -: <br /> 545-112(4/08) <br /> I <br />