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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 1 f <br /> (; ¶ Q- I / SS M e-Y EI Zoning Status;CUP; <br /> OWNER ADDRESS (Number, reet,C` ',State,Zip) Deed Restriction; CSM <br /> c90 1 w• -13 0 t''w q c) J L3-13 ci Variance(# ) <br /> HOME NONE CELL PHONE E AIL ADDRESS <br /> E 0 J ,°S.-- r . 9 V W o tr.K ek • A0L .Cow 17 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTACTOR NAME j� <br /> C.�C k S O2tJMa IA n S 1.c/..,gv; )c r r��L 1 -r ®Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ..3185 OPP.0 CO;ni- 'Dcgd 3/PSP.Q.�e� �■. //,,-∎ v <br /> (City,State,Zip) (City,State,Z ) _ G 0 Setbacks <br /> Skou aslnk-ar W .5 3 5 89 , �h� 00- <br /> PHONE PH NE 0.Site Plan approval from <br /> 6og_8?7 - t 13 I 60 c3 77 /) 3 J applicable township. <br /> E-MAIL ADDRESS p E-MAIL A•DR <br /> �t;sQ. S\naabv11c2ev.S•Cor-• tneocik s , wfL, e,..6 .co MFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ®Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONIN ACREAGE: <br /> El NUMBER Oa e d 6>0.2.3.29/0 j- 9 frontage drawn to scale. <br /> TOWNSHIP: CT ON: <br /> f t� r ok3 1/4: 1/41/4: ,®Driveway permits <br /> ADDRESS: (state,county,town) <br /> IECSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> 1 633 (public,private) <br /> PROPOSED PROJECT INFORMATION "°" ""'" <br /> PROJECT D CRIPTION: '■ S K <br /> _____�/L• iat___ - gib• `2 ♦ f ® Zo`ng D s £ <br /> `' <br /> . elThis project is a new building or structure. ® •e <br /> This project is an addition/alteration to an existing building or structure. €4-k 3 <br /> SANITARY SERVICE: PERMIT NUMBER: U of i•, �I <br /> EWER KEPTIC / —C7761// 6 © !//J q newe S 3 g f. <br /> HEIGHT IN FE i i( NUMBER OF STORIES: (Not including basement) r �_ a� <br /> i 11 o d( oodplal : _:,. <br /> St o ela dtatta me <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 4' <br /> BASEMENT: 1ST FLOOR: ® �COSI.4 O t Ol pe 1 <br /> TOTAL SQUARE FOOTAGE: S(o•e •Is urba ce <br /> 3200 filling access 1 x � <br /> 2ND FLOOR: 3RD FLOOR: s`� n t <br /> ® Rev eV.ocatton Su a ey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ end available o• 10 S.- ' <br /> (Please round to nearest dollar) ,. <br /> .P00, 0 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies KANo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres alo QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes a o <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 to EDon't know <br /> 7. Is this to correct a violation? Eyes a <br /> 545-112(4/08) Z- A 0 I Uv f� APPLICATION MUST BE SIGNED <br /> r (Continue on Back) ■ —► <br />