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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY.OWNED INFORMATION ;2_ ;' '` : 4,?4'.:; '-'='-••••''-'-';5-';',1-'-1-Z`_ CUSTOMER TO PROVI E <br /> OWNER NAME <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status;CUP; <br /> �crrTAL� ����'�� eed Restriction;CSM ►4 p� <br /> 3,96o L A tit)0 ROAM uJ/5 CV/✓S1n/ 53527 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS C <br /> 6 Y3 7 Sy 29 taae &16—5-?.'s (i,, cal' ,0.//k/=S spy°j @ 14 4 -C0/A ik Site Plan drawn to scale <br /> AGENT INFORMATION. • , CONTRACTOR:INFORMATION -nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> A/147/EL , ,''G/2v>o Site Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3660 Log//00/1/ 1co/7.0 St/i 7 <br /> (Ci ,State,Zip) 3 2 7 (City,State,Zip) ON Setbacks <br /> C o77A 6 E` &4fCi A= e4 <br /> PHONE PHONE O! Site Plan approval from <br /> 6l 1— S 4/Zg applicable township: <br /> E-MAIL ADDRESS /�'r E-MAIL ADDRESS . r 6,�/n/S <br /> Gt/i Nl��/P//vi--S .55"2 67 Aet. Floor plans to scale l` <br /> PROPERTY/LOCATION INFORMATION '.:(http:1/accessdane.co:dane wi.us/} 0" I `A <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ' Elevation of property 6 <br /> D NUMBER 0/Q,1©.,i/-Z2./-9/9,,/- R-IA / 377 frontage drawn to scale. <br /> TOWNSHIP: SECTION: 1 <br /> Afel- <br /> LA-77-7-116 Gi?octc- 2-2_ 1/4: (VE %IA: S w` �`1 Driveway permit <br /> ADDRESS: state,COUn O n <br /> ":? ;?6U L_/I first/ fc 0, z) F Sanita .- ••' <br /> CSM: LOT SUBDIVISIOJ BLOCK/LOT Ubl± 4, <br /> C5/1ii COSI// y (p priv- e <br /> PROPOSED PROJECT INFORMATION Ila <br /> kr .PROJECTDESCRIPTIOD" <br /> 2 / x 0 LJ E T7iC#'/ !) 6/4/416- 7---_ rC t° -�e`4?)-If,, 1)1 ., =r <br /> This project is a new building or structure. m z ( ti <br /> ❑This project is an addition/alteration to an existing building or structure. 'r ' �� <br /> SANITARY SERVICE: PERMIT NU ER: ¢s(k,°Sa r ,, <br /> ❑SEWER ❑SEPTIC 0� r®0 � <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> i �"�r 2,,,,;,...._s„a' Mist r r' : r, • <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) :- r r }; 0 <br /> BASEMENT: 1ST FLOOR: 1 t <br /> 4,. TOTAL SQUARE FOOTAGE: -s ti° +-41 r xt� : ' , , A- <br /> , i <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST g � ' (IN t L�/ <br /> (Please round to nearest dollar) '"� '� —* O�DG) V ” IPf° " ° ;Y, <br /> 1. The property is within 300 feet of a stream or 1000 feat from a pond or lake? LI Yes Q No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property' ❑Yes 0 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 121-Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Q 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) ❑Yes CI No ❑Don't know <br /> 7. Is this to correct a violation? , ❑Yes QTIO <br /> APPLICATION MUST BE SIGNED <br /> Continue on Back -i -;► -► <br /> 54S?12 14/08) ( ) <br />