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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 513/1/ 4 Co/IMF /11orrr5 ❑Zoning Statu ; UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> /0/ate 7741, P,32 ,Lcl B I kE /l?o u n ols (Lt S.I S 17 D d Re ction; CSM <br /> anace(# ) <br /> HO ,E PHONE CELL PHONE E-MAIL ADDRESS <br /> 437' 6135 6s/-4oz- /9ID J '3 6f-A4 ffi Z At r- a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tod 1-17+ cir(c4 SIX /44-4615- I>S.(GAI ' e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3'Y' A; g4` .S 3o1 /V 8'!-4. ST- <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Mt, 1-1.0,24_8, Cur S3S 72 NH-, N.o2F13 wr S-35-7 - <br /> PHONE PHONE ❑Si PI proval from <br /> 60 B' 5-76 —6-7 4/ 60g .S?6- 6? 41 • ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jkh4Ad(''iCJLeA/1/• i1�r 7K4,44.nLRtc462 M14-rC• /1Er Fl or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Ievation of property <br /> ❑PARCEL 0 6 0/o -3 4/ - 4 '4-L 16,45-€ frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 07 i a2M onT 34 %: gE- 1/41/,: 3 W ❑Drive permits <br /> ADDRESS: (st ,county 'n) <br /> loi a-7 TN-u,hP 2 J LitE /'16(4,4,41, c,j- s.5- 17 <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sani permits <br /> 05 30 7 / (p lc,private) <br /> PROPOSED PROJECT INFORMATION F REVIEW <br /> PROJECT DESCRIPTION: <br /> Q&ThO1iE. G.kB�L 2occ-�/Mb ft.p, 1movl ASG-14dhecs !kC`K//1>:4coc/1 147 s,�h-CE_ a Z ing District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> El This project is an addition/alteration to an existing building or structure. �� <br /> SANITARY SERVICE: PERMIT NUMBER: CI RUra 'r-+'+: <br /> EWER [EPTIC (n: existing <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> t3/.._ I r I % ❑ Wetland/F plain/ <br /> AREA TO NEAREST SQUARE FOOT: loth 3 Sh nd (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Erosion permit <br /> BASEMENT: 1ST FLOOR: <br /> Oki 3 + TOTAL SQUARE FOOTAGE: j ( ,disturbance, <br /> �� fi ' g/acxess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0.0 <br /> Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: oo <br /> (Please round to nearest dollar) ♦ .. 'O. -4 -4 $ ?? _D0 — and available options. �/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes ['lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes EJVo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Jo <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) f Yes 'lo ❑Don't know <br /> 7. Is this to correct a violation? :Yes I'lo <br /> 0 APPLICATION MUST BE SIGNED- <br /> 545-112(4/08) <br /> v (Continue on Back) ■ -4. -■ <br />