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-'1,---1- S <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> NER NAME <br /> U,6,---2 r ``/G"'`,c `i Zoning Status;CUP; <br /> �( OWNER ADDRESS (Number,Stre t,City,State,Zip) eed Restriction;CSM <br /> j <br /> \ HOME�ON C C'l�HO E-MAIL ADDRESS Variance(# ) <br /> i q R 61° ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME nn CONTRACTOR NAME <br /> �T"OA f.)t(--C-tA-NA-,./ 14 v F 7`o A 0 s:ci ❑ Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ofell/septic <br /> X175 F- 14zht 211v l c-w at- q 7s fi pic�q-J21 ,�,, 0,5 o� <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> /"4t,,. ro•/ to 5R50'I 4-.0Ce%�T-�v to ,53.53 <br /> PHONE t PHONE vi, ite I approval from <br /> (e(,,cd 481(It— 1120-o (Q� DI ccl` ''22O a etownship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floiians to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Ete i Of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑ NUMBER O5!2 o 8.i1$G DU S /q- I ? °I ) g fro g awn to scale. <br /> TOWNSHIP: SECTIO N: <br /> /4/L/J oJ U- 1/4: /v 44: <br /> 5 ❑ l Df ermits <br /> (sta nty,town) <br /> n)ADDRESS: <br /> qo(O Lmri- 26 /4- <br /> ❑ itary mits <br /> CSM: A v^`, SUBDIVISION BLOCK/LOT (P ub' , rivate <br /> ) <br /> PROPOSED PROJECT INFORMATION STAFF EVIEW <br /> PRRJECT DESCRATION: <br /> ls0 L, t)f_ Ie, _, '`toning District <br /> -This project is a new building or structure. U.Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. / <br /> SANITARY SERVICE: PERMIT NUMBE <br /> Rur. , •,•ress <br /> ❑SEWER SEPTIC 'e a tStt�` <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) Wet, eY rs+ <br /> _._ Main/ <br /> AREA TO NEAREST SQUARE FOOT: ` ' " (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) _ <br /> BASEMENT: 1ST FL ® s ' 1 iMit <br /> 4, TOTAL SQUARE FOOTAGE: 4 `-1.=a -P,.. b ,2ND FLOOR: 3RD FLOOR: G� fillfng/a S} <br /> L1 S 1 Review . - o Survey <br /> ESTIMATED CONSTRUCTION COST: / G, nd ava`-��► ••bons. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ -4. - /0/ (� �p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes -=0:145 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes c llo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? , s----10-■o <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 ❑Don't know <br /> 7. Is this to correct a violation? DYes . No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />