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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEit NAME <br /> V 2.1•� 'e. o II ' 1...L.--L Zoning Status;CUP; — ) <br /> •,'• 5.. -s(Number.`eat,C , te,za eed Restriciion;CSM <br /> i 01 + 1 e 1,0 ts)-f 1 f lit I-elm -~. /i Variance(# ) <br /> HO CELL PHONE E.MNL ADDRESS <br /> ' '3tt p site Plan drawn to scale / <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and Includes dimensions t <br /> • <br /> AGENT NAME CONTRACTOR NAME <br /> 1r 6 ' S i'. a Ile 1►' Site P • tiding location <br /> •. CONTRACTOR ADDRESS = r:r :O <br /> (MY.Slate.ZIP) ( :state.rip) Setbacks (3 0/ • /• 6---6 <br /> PHONE PHONE • I' Its Plan approval from <br /> . - applicable township: 4- <br /> E-MAILADDRESS E•MAILADDRESS <br /> XFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:f.accessdane.co.dane.wi.us() Elevation of property <br /> PAR P ER Cu NG: <br /> ENT frontage dfaYV1T to scale. <br /> TOWNSHIP \\ `` II 1/a: %IA: .....0 E..1. tArivewayperrnt�1 y` <br /> c�cl1 1 u , (state,coon CO <br /> ADDRESS: • <br /> ar elk j ✓ • OSenita .,, • <br /> CSM: LOT ,,‘ BLOCK/LOT <br /> U i UCHPCll0 <br /> PROPOSED PROJECT INFORMATION f71 <br /> . PROJECTa7ESCRiPTlON: ' r� _ 1 <br /> Q,t,�f uAS 'ra�L.f;� <br /> ® Is project is a new building or structure. . <)C <br /> • O This project is an addition/alteration to an existing banding or structure. <br /> _ I=1.1:1e..:■1--4a'4 — PERMIT.IIIMBFR• -- —'••- --- <br /> L SEWER ❑SEPTIC ',. 0/6 — /'I .'0 <br /> HEIGHT IN FEET: 3 d 1 • NUMBER OF STORIES: (Not Including re basement) <br /> AREA TO NEAREST SQUARE FOOT. L <br /> (Outside dimensions including unfinished area,attached• •g and above grade decks or porches) '! <br /> BASEMENT ..t <br /> /59/ G3 �TOTAL S•U,.; FOOT/1'E: <br /> 7 v ��sl <br /> 2ND FLOOR: 3RD FLOOR: sy 70-A-fp ► <br /> y 7 a <br /> yes <br /> ESTIMATED CONSTRUCTION COST. ♦ ♦ ♦ ♦ $ 5 L •i 00 <br /> (Please round to nearest dollar) 7 , • ��. <br /> 1. The property is within 300 feet of a stream or 4000 feet from a pond or lake? D.Yes eglo .0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes ( 'No ❑Don't know <br /> 3..Have you talked with the township about your project and are they In agreement? Lyes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Wes ONo <br /> 5. Is this project associated-with a rezone/CUP/variance(petition/appeal# ) ,(I a blank if none) <br /> ( <br /> 6. Is a location survey required? (see reverse) t'es ❑No ❑Don't know <br /> 7. is this to correct a violation? ❑Yes Ni/No <br /> I ' A �► �� APPLICATION MUST BE SIGNED <br /> 545.112(noel $ y•l/P (Continua on Back) -+ -4 -0 <br />