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,, ... Q' C't()\1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com ...SUPPLEMENT to Web•App# <br /> PROPERTY OWNER.INFORMATION 4,..,•;:: •_,z_;:; ;'3.-;WP `XV.�,.;,; _. -. : < :5?, -1;_ :` CUSTOMER TO PROVIDE <br /> OWNER NAME� i <br /> � n,� �,l/ �^ <br /> Fh+ VV �ID'e'c.. � <br /> OWNER ADDRESS Number,Street City,State,Zip) ❑ Zoning Status;CUP; <br /> �r a ,f�, Deed Restriction;CSM <br /> (p~1 Kg nd,e/1 �t�, COH& eG't -c w I 5357`7 Variance(# ) <br /> i <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> —^—^ i- <br /> ',b -101C1 dq st <br /> K Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION. ;-: .s and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> MtCVC-• 1-'-ppk";14 'i Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> aU i o d c►& R-41 <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> C.A,tv09Y 1 c ', tiv( S 3s-L3 <br /> PHONE PHONE ❑ Site Plan approval from <br /> Con—33; -3'241 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ---- (r Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION ;(http:l/accessdane.co:dane.wi.usn ❑ Elevation of property <br /> PARENT PARCEL NU BER: CURRENT ONING: ACREAGE: p P rty <br /> ❑ PARCEL O_`Cc.60"-//2- 4-- ,k I o- 9 u•`3 frontage drawn to scale. <br /> NUMBER _l ` f <br /> TOWNSHIP: 9'y../s--- 7 SECTION: <br /> P Le c 1 c r,�i 1 ,/: f4,/, 1/4%: tl W ❑ Driveway permits <br /> ADDRESS: <br /> ^i (j� , (state,county,town) <br /> Ic( V-77 infat'N 00A-0 C6t'Aq� f 1^000. ❑ Sanitary permits <br /> CSM: ] LOT SUBDIVISION Q :LOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION -- i . T - <br /> PRO,)ECT DESCRIPTION: <br /> C Q a. fla a & ¢r` y ' <br /> � e S� w t--� raut Z- - (- �uR r-ev�u�rc�� � 7T ,n s <br /> 2 This project is a new building or struc ure. ,- <br /> ❑This project is an addition/alteration to an existing building or structure. -- f - <br /> SANITARY SERVICE: PERMIT NUMBER: #44, .F `. <br /> ❑SEWER 0 SEPTIC .t'` .� _,,,` <br /> sic - s^g � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 1 -- - � :` <br /> CD 1 f IE�S �I,�. Ata' ' . . <br /> I AREA TO NEAREST SQUARE FOOT: ii• " it" <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) = �.- <br /> BASEMENT 1ST FLOOR: b �� ® <br /> ot y `i 31 j TOTAL SQUARE FOOTAGE: j• i liri - ` <br /> 2ND FLOOR: 3RD OOR: `;704 � ;. <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► ♦ ♦ / /�/� ve d s <br /> (Please round to nearest dollar) LO P° ~�� L_ + ,,° <br /> ''1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li Yes JZ1No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ANo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes f 21No <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? k ❑Yes 4 N <br /> � <br /> �� I V T BIG <br /> (Continue APPLICATION on BackMUS) B. S—► ►NED— <br /> 545-112(4/08) <br />