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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App#- <br /> PROPERTY OWNER.INFORMATION ;;. , ..„_. -fi° ,.-.W W,. ;; .:=1,-;-,:-"'.'-',i : ,- CUSTOMER TO PROVID <br /> OWNER NAME <br /> emo OWNER ADDRESS (Number,Ste�City,State,Zip) `M Zoning Status;CUP; i L V <br /> 1975 Sw1 PI-.fc )4I(G,L 1,-. , j1,'id/P ioh 4/1 5-,�s12i Variance(t#riction;CSM ) 4 3 7 <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> a— /— 7 0 G <br /> Ve,,t/'1 i 4P) . f T" A Site Plan drawn to scale <br /> AGENT INFORMATION - CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> :ilr . 'i." il,, ❑ S' _ • , location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ,ell/septic <br /> • <br /> (City,State,Zip) (City,State,Zip) jii Setbacks 7e/n//1 / <br /> PHONE PHONE i' 'e Plan approval from / /4-applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Oir-4 loor plans to scale <br /> PROPERTY/LOCATION INFORMATION .:(http:7laccessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRE ONI G: ACREAGE: '=� Elevation of property <br /> ❑ PARCEL 09.0 0_ 3))_2243- / ontage drawn to scale. <br /> NUMBER t7 0 �� /�2sf�Cr-Qr <br /> TOWNSHIP: SECTION: j �I <br /> cE r/he. Aid 3/1 Y4: Al L- 1/4%.. A �Drivewayper <br /> ADDREs: / ,,�1 / (state,county own <br /> x{975- SinriTe r"i�CP /�i/�cd-0,7 AI/ 7' Sanitary•- <br /> CSM: LOT cl SUBDIVISION BLOCK/LOT (publi.d'i - <br /> PROPOSED PROJECT INFORMATION. ' . ''-. '��, <br /> PROJECT DESCRIPTION: Q . '-a L <br /> ❑This project is a new building or structure. e: e <br /> tikThis project is an addition/alteration to an existing building or structure. r it <br /> SANITARY SERVICE: PERMIT NUMBER: rn-r I1"+°`'r <br /> C O�rbd yr- <br /> ?❑SEWER )(SEPTIC <br /> HEIGHT IN FEET <br /> NUMBER OF STORIES: (Not including basement) ' a r r <br /> AREA TO NEAREST SQUARE FOOT: 4F-? i q <br /> i i <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �-,f,--,,,:,.:-,:-.,4-:.,:'':-,'` <br /> i, <br /> BASEMENT 1 OAR ¢� ®� ��lt�g�I ) �� <br /> 4, TOTAL SQUARE FOOTAGE: l,..it ad3 <br /> 2ND FLOOR: 3 /r� 3RD FL a OR: T mss. / * 'µ° r, <br /> Q k <br /> ESTIMATED CONSTRUCTION COST -i ♦ ♦ ♦ ..+ ♦ $ t� 0 co 0 CV �� 4 <br /> �'&.'� g 1='o �a 9;e x <br /> (Please round to nearest dollar <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes igiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0 N ❑Don't know 9 3. Have you talked with the township about your project and are they in agreement? ❑Yes 'No 0 v) 0 2- 3 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No ��t4(41/ <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 Callo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes figNo <br /> r/ <br /> g _3» 2 2 y 3 , ✓ APPLICATION MUST BE SIGNED <br /> U (� (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />