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7 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWt2193 NAME / / • <br /> S°'"' V17'✓7 r fi ning Status; CUP; <br /> OWNER ADDRESS (Nu ber, et,cityy,State,Zip) /`� r? Deed Restriction; CSM <br /> HOME HONE IA 145 CELL oHO E IV ( /f c,c RA 6 v_1 y 3 5 Q 7 Varia ce(# ) <br /> boi ` Lb-5 Did ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ' i i' Plan approval from <br /> ap licable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floor laps to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CU-RENT ZONING: ACREAGE: <br /> ❑ PARCEL /�.^, (� 71/12 9 S frontage drawn to scale. <br /> NUMBER V� 0�07�� -'O �� 1 <br /> TOWNSHIP: SECTION: <br /> C.517 4a 6/Q v e 0 7 1/a: 5& 1/a'/a: s l,..J Ive,count permits <br /> ADDRESS: (state,county,town) <br /> L49 3 ()l / 5 H0/e kJ 6,40,‘ Geblfe 77Sc� rA',-1 itary p ita 1 i <br /> CSM: LOT SUBDIVISION LOCK/LOT <br /> (public, , <br /> 1 ! <br /> PROPOSED PROJECT INFORMATION "STAFF REVIEW <br /> PROJECT DESCRIPTION � rt✓ / <br /> e G IQ ea C Zonin 13istrict <br /> This project is a new building or structure ❑ ermined Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ /Rural Ac. <br /> ❑ ( <br /> - <br /> SEWER JO SEPTIC ew - + ing <br /> HEIGHT IN FEET: A NUMBER OF STORIES: (Not including basement) ,11 4®a-tiaztdlFfoodpistly <br /> S i—Ge+ Share (attaChMent) <br /> AREA TO NEAREST SQUARE FOOT: ,..••• +' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 6/fr <br /> lOSiiNiCOittro �ITIlt <br /> 2ND FLOOR: 3Ra it OR,) - TOTAL •SQUARE FOOTAGE: , (slopes,distil' ,,=' <br /> 2 7� fllli access) <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) �j/( CO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es No ❑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'? f 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 with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) lYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes p No <br /> APPLICATION MU BE SIGNED <br /> 545-112(4/08) (Continue On Back)ST -► <br />