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ZONING PERMIT APPLICATION www.countyofdane.com i3 <br /> 1 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 4 A 1 e. A.. ❑ Zoning Stat UP; <br /> OWNER ADDRESS (Number,jet,et,City,State,Zip) Deed R tction; CSM <br /> _2 Z. / (nu ., � £� ri e(# ) <br /> HOME PHONE CE PHO E E-MAIL E-MAILADDRESS <br /> L -�/1 .'O Co • ' ;iel • f-' S'a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Oct 1 Q 0 e e_e_53-e sa-3 I Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> 9za ,' /1/ / <br /> (City,State,Zip) (City,State,Zip) 1 Setbacks <br /> 6c e, u).1 5-3e67 <br /> PHONE PHONE ❑ Site Plan royal from <br /> ( oe) 7PQ-Zboc 778-20W plic a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> daps , 4 s s e..i OA 4 f , - f— I oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT I PARCEL NUMBER: u CUR ENTZONI G: \ ACREAGE: Elevation of property <br /> LI NUMBER ( b(od(o--2z1--553.0-o R - (Q.) 9. 32/5 <br /> fr ntage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> � t n 1/4: '/a'/4: 1 ri way permits <br /> [ kt hi ok (s te,county,town) <br /> ADDRESS: <br /> .7 "O1 lit..,' (.„, E mo,..,,t #0,e4 tug 3S72, i anitary permits <br /> csM: I66T SUBDIVISION BLOCK/LOT (public,private) <br /> 1/ yz <br /> . PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 1 /� l.. �m <br /> owe '1(^J ' I Wing District <br /> . lathis'project is a new building or structure. OBR ermitted Use? <br /> 3'-Zs_ny <br /> U This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ��,,// P 4 RERMIT NUMBER: a `ddress <br /> ❑SEWER 1GSEPTIC $/e >17 ,end:xisfing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 30 G " Z ' - 'W and/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: oreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: pe ak 5-4_0 ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> Z Stay ZSey ep-.t. 14-7/e, Q3 filing/access) <br /> 2ND FLOOR: 3RD FLOOR: z� <br /> � Y3 l Y i v .. Review L 'ton Survey <br /> ESTIMATED CONSTRUCTION COST: and a able options. <br /> (Please round to nearest dollar) -► ♦ ♦ ♦ ♦ ♦ $ .OD/ 000 w <br /> 7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 1IYes U No U Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lt<(es J No U Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes U <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan I none) <br /> 6. Is a location survey required? (see reverse) U Yes o U Don't know <br /> 7. Is this to correct a violation? U Yes I No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />