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ZONING PERMIT APPLICATION www countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> S 1 )Ali- 1 y� Jt,D G Sot') <br /> OWNER ADDRESS (Number,sir c;q,,state, ❑ Zoni)l Deed f s;CUP; <br /> �,q3 1.._0A.� j(1(- riction;CSM <br /> HOME PHONE CELL PHONE E •DRESS Variance(# ) <br /> - 921- 3s g� .�,- ?9 062` ‘1-1- `� C�•1�}-�'e.r . � <br /> ❑ Site Plan drawn cane <br /> AGENT INFORMATION j CONTRACTOR INFORMATION and includetfimensions <br /> AGENT NAME • • TOR NAME <br /> S — 41 �Qot.G ❑ Site Pla i uding location <br /> AGENT ADDRESS CONT OR ADDRESS of weH/s tic <br /> (City,State,Zip) (City,State.Zip) ❑ Setb Cks <br /> PHONE PHONE ❑ Site PjaI-i t.r• I from <br /> appl ' •' ship- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor planlyagle <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CU RENTZ ING- ACREAGE ❑ Elevatio of petty <br /> ❑ NUMBER 0?e/6�0 L-O81 -S IS/_d t gej� I(o (, frontage wn to scale. <br /> TOWNSHIP: SECTION# <br /> Iue �0u,,)D.s ,r.: w : ❑ Drivew pe <br /> ADD ESS: tt)(4� f (state,co ,town) <br /> (/� �- ❑ Sanita permits <br /> CSM: LOT SUBDMSION BLOCK/LOT 0 <br /> 2.--- (publi6,private) rc4A <br /> PROPOSED PROJECT INFORMATION S . RE <br /> PROJE,Cj DESCRIPTION <br /> �., . <br /> • This project is a new building or structure. .k t <br /> ❑This project is an addition/alteration to an existing building or structure. ; <br /> r <br /> SANRARY SERVICE: PERMIT NUMBER: �$rt ::4'.,',-- ''...5 .-:7',-. '-- --1..5.v' .--;-=11:",_-,-{ <br /> (SEWER IEPTIC I ^2m/lr _ O p /t/a ' <br /> HEIGHT IN FEET /`�,} //) NUMBER OF STORIES: (Not including basement) la <br /> Ica , L/ I �P 4 " # S D-' <br /> AREA TO NEAREST SQUARE FOOT: 4 `' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r - n <br /> ,0-r r1OR: / _: <br /> BA dEtcl e -sal 0� ✓ 4 TOTAL SQUARE FOOTAGE: 4, 7 , Q <br /> artu rLWK _ r ; <br /> 2ND FLOOR: I <br /> S <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ "� '♦ "► "► '► s—i C�Dp $ ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li Yes 4 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? E'S'es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? El 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) CI yes n No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0„ No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/05) (Continue on Back) -0- -0- <br />