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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME 1 <br /> C7 °1/4- 1 s SS 1 e ,�]Zoning Status; CUP; <br /> OWNER ADDRESS (Number, reef, State,Zip) Deed Restriction; CSM b 3y� <br /> �'� W' O �''� c� w��`a� Variance(# ) <br /> HOME PHONE CELL PHONE E AIL ADDRESS <br /> s©U J� 9 Y W 0c.K'ek AOL .CoI\ al Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ,, 11 CO RACTOR NAME <br /> G hC S N2U Ma n n S J &, �� r,31-1)e,57 ®Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 185 OeP.c Vo nk' 'Dn'd 3/65-�� D� v <br /> (City,State,Zip) (City,State,Z ) Setbacks <br /> -k-0%)%16‘171.‘ ws S 5'89 �r/ �� 5 5g� <br /> PHONE PH NE Site Plan approval from <br /> cog-2;17 - �`3 I �� g 77 /) 3 ' applicable township. <br /> E-MAIL ADDRESS n E-MAILA'DR <br /> �t�S <br /> Q. s tout�a�C S•Co r.‘ S ,_t,�Lo L'' eS .Car �Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ®Elevation of property <br /> PARENT PARCEL NUMBER: RENTZONIN ACREAGE: <br /> n NUMBER oa e 017 <br /> >©�3�9�0 �- 9 frontage drawn to scale. <br /> TOWNSHIP: SECT ON: r ' c <br /> D t) ‘CN .‘(- <br /> �� ,/,: N t�/ ,/4,/4. c� W Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> 2- 3 / &' ye "-Se ,. J'2oN <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> V,b3J (public,private) <br /> PROPOSED PROJECT INFORMATION „,PROJECT D CRIPTION: ,0 Z <br /> 'C''''-;1 -lit-thiCt.-" -,-.:':'-:',-- ^. This project is a new building or structure. , y. ! �/ <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 4re etas:,,,4 <br /> 3 1 © J ,� <br /> EWER �EPTIC � �D � .� � �/ �� b v=�� 1 � � ,t > <br /> HEIGHT IN 9�, NUMBER OF SO RIES: (Not including basement) <br /> a <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: FLOQf�R:74Mit <br /> S V + TOTA�I QUARE FOOTAGE: + •• + + <br /> 2ND FLOOR: 3RD FLOOR: �� iQU ) �% <br /> ESTIMATED CONSTRUCTION COST: ���(Ple ase round to nearest dollar) $ 000 .Q(� c1 <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? <br /> oyes �Vo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes �'Jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes 'lo <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) QYes Vo DDon't know <br /> 7. Is this to correct a violation? lYes 'lo <br /> 2 ?t ,J APPLICATION MUST BE SIGNED <br /> 545-112(4/08) / (Continue On Back) <br /> r <br />