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, <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE C..-1�sG� ' a S. :_l Zoning Status; CUP; <br /> OWNE ADDRESS Number. eet.City.State,Zip) <br /> Co G� t+ �� ^D y�, e Deed Restriction;CSM <br /> OM PHONE CELOL HONE o J 1' 1` l s U�� �� Variance(.# ) <br /> E-MAIL ADDRESS � �! <br /> • � <br /> t'''°: "-- -04::: . - 0 ?I C sd.e.nu ),SOn i t ,Cr,m U Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION <br /> AGENT NAME CONTRACTOR NAME <br /> and includes dimensions 1 <br /> AGENT ADDRESS ` 4—S B '^ <br /> rOGtei h-,a--> 3 Site Plan including location <br /> CONTRACTOR ADDRESS of well/septic <br /> • - Ike 1.•... -S 1- <br /> (City,State,Tip) (City,State,Zip) ` U Setbacks <br /> PHONE - It. • or n S C' <br /> PHONE U Site Plan approval from <br /> (. o - Y?3— 7>`1-01 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS _ <br /> U Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httta laccessdaneCURRENT .co.dane.wi.ust) <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: U Elevation of property <br /> PARCEL <br /> U NUMBER 10 Y10—WI-- (�O—7 1 't/c�, a s frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> IS t.k.CV-----C, 1/44: 1Y: Driveway permits <br /> : /c I S-- >C-)51- (state,county,town) <br /> wn)ADDRESS s o}1, (--1-TL.. Li Sanitary permits LOT l ma SUBDIVISION <br /> BLOCKLOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PRn FrT 0 SCR! TION; D <br /> il�t S ON: (',JY,c-k, �31Sf ' r.,,,, '�c)r--}O o � ,e.V�� <br /> ��1 X13 r � .CP:, T �3 3 b it 40,rt-t, 4�0r ''` bz n-,s, jo I` . .f}tt .k rict <br /> • ❑This project is a new building or structure. ,�,xrt�(t Li7O t�^�"I?- �' <br /> This project is an addition/alteration to an existing building or structure. dcor., -y <br /> SANITARY SERVICE: PERMIT NUMBER: Rural A s <br /> U SEWER SEPTIC (new/existing <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 Fla 3 WettancAtodpfain/ <br /> AREA TO NEAREST SQUARE FOOT: ` 70>r #tfSER <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Li E!-o .sioncontnopermit <br /> BASEMENT: 1ST FLOOR: <br /> 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> tiningi 2ND FLOOR: 3RD FLOOR. <br /> l Q Review f ion Survey <br /> ESTI MATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ i�Uptif9C14, <br /> (Please round to nearest dollar) $ I �/ 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? UYes O Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes BSI No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes U No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? U Yes No <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) UYes ANo U Don't know <br /> 7. Is this to correct a violation? J Yes *Jo <br /> APPLICATION MUST BE SIGNED <br /> ;;.5.112:4.11.1) (Continue on Back) -► -I* -■ <br /> A location survey, by a licensed surveyor, is required if your construction <br />