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. . - nil <br /> ZONING PERMIT APPLICATION www.4ofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAVE <br /> 505 Vs,ejoutt.,(A Zoning Status; CUP; <br /> OWNER ADDRESS ( mber,Street,City,State,Zip) Deed Restriction; CSM <br /> '3 3 I 7 //'t/g4w �/ 0/c 641,ii,J w. S3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /0 !-13 y- ( Z 5 a.Hti� /two/'2 Gov.L e l,�i '`('•ce>•-L 31 drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jas t:/ m,e..y>, 2)--ay C use_(rh-a..",__ ❑ Ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3 3 /7 ►$rv7 f.c,i- e( 3 3(7 Ifni f e>i- '/ <br /> (City,State,Zip) (City,State,Zip) /Setbacks <br /> 1411_ F�+'�•�. 10- S 3(72 Mc_ F.,,44.". ` u./.0 53 c-51 <br /> PHONE PHONE Plan approval from <br /> (1 _ 2 3 9-c{(c{ Z Ede_Z39-y/y� app able township. <br /> E-MAIL ADDRESS E-MAIL DDRESS <br /> A/Cr, 2 Good e/4 6 ( «, evt, Z Gov( & 11/4 lot 0f7 toy Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CUR ENT ZONING: ACREAGE: <br /> ❑ PARCEL / q Z 7�0 frontage drawn to scale. <br /> NUMBER 06 1/07/0-352- ree -? <br /> TOWNSHIP: SECTION: <br /> I3/00mlln f 6r' '< - 0 7 3 5 1/4: N 09 //4:1 + 5 Es II/.. iveway permits <br /> / (state,county,town) <br /> ADDRESS: <br /> 33 r7 s" etree._ nitary permits <br /> CSM: / / LOT SUBDIVISION BLOCK/LOT public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJE T DESCRIPTION: <br /> cTa,-1e act,(--H04 oning District <br /> . ❑This project is a new building or structure. <br /> eerrnitted Use? <br /> ®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ,Ural Address <br /> ❑SEWER 14 SEPTIC (new -xi. g) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ( 3 / `Wetland/Floodplain/ <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: �osionControl permit <br /> I TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> , filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> -051119-' �� ew Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ��� and available options. <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 [INo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ©Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes ❑No <br /> 5. Is this project associated wi arezone/GUP/variance(petition/appeal# ) (leave blank if none).__ <br /> 6: s a location survey required? (see reverse) ❑Yes TA No ❑Don't know/ <br /> ❑Yes W No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -o. -► <br /> 545-112(4/08) <br />