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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> AST CRC WE aZoning Status; CUP; <br /> JWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1 S SaoorY1 S-r MPV%S J WS 637b3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-335-,Bag. ccowe nate on Q 'malt - Co M 5Z1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C`nf t S N evmo Ti IN Sono-u3 131/4/118 i A 9 0 es igv1 .kin C. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 318 5 Deer Po %n� Or- 3185 Deer Po'111k Or <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> \filbv61-rTo (A)S 53589 STO t-tTOIJ OJT 535-8q <br /> ONE PHONE .Site Plan approval from <br /> 6Og -077 -1131 605 - 5377 - 11 31 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> he i s@-. Shaw by I I d{_CS. Cora 616 S ' Sha a bvi/de I'S S.Coin g Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �(Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: `°� P P Y <br /> ❑VmcBER /06/0806-321-9780-0 RA-3 9 6q,6 IS frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> SLAC1c EARTH 3a '/4: SE. '/41/: NE El Driveway permits <br /> F{DDRE s: (state,county,town) <br /> �,/ I 0 S�� Sv+C-/1*e fej I Sanita permits gk9 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ry p 3 <br /> 121c17 I (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: �� s 01 <br /> let..) cAM1L1/4 t' ' - ` <br /> This project is a new building or structure. e <br /> µ-. <br /> El This project is an addition/alteration to an existing building or structure. � <br /> SANITARY SERVICE: <br /> PERMIT NUMBER: � * <br /> /3- aoi6 - 000S <br /> EWER EPTIC t �r <br /> EIGHT IN FEET: �� <br /> NUMBER OF STORIES: (Not including basement) <br /> aW-a i=/7 1 % - ri EA TO AREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) t! <br /> BASEMENT: 1ST FLOOR: � '-` <br /> 9.539. Q 8 16 4, TOTAL SQUARE FOOTAGE: - <br /> J �� <br /> 2ND FLOOR: 3RD FLOOR: 4 <br /> 1 1 0 7S <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) gOQ ©OQ � ��, <br /> Y0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes "lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the"township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes 14\10 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 , lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes R'Jo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -, ■ -► <br />