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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 /> PA I G"G V A I"t N r Zoning Status;CUP; <br /> OWNER ADDRESS (Nunmber,Street,City,St te,Zip) led Restriction; CSM <br /> ' G y7 A-ir'porl Rd , ; C/c�/ .fry , WT 53J 6 2 <br /> Va lance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> V3. .33 9a Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> N : - Plan including location <br /> AGENT ADDRESS CONTRACTOR ADD RE ,fwell/septic <br /> (City,State,Zip) (City,State,Zip) •' etba ks <br /> PHONE PHONE gSite • -n approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> �Dloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us`) <br /> PARENT PARCEL NUMBER: CURR TZONIN ACR AGE: I Eleva •• • property <br /> LI NUMBER O'"? %°Gt-J O> S .0-- Ont-.e awn to scale. <br /> TOWNSHIP: SECTI <br /> M /c!d I t 1/a: S 1/41/4: Drivewa er Is <br /> ADDRESS: <br /> (state, • ,ty,town) <br /> $6 y3 A.1-P° )2c-I pi,de/le 4-1, , cir s 3s b z <br /> CSM: �S.�' LOT SUBDIVISION BLOCK/LOT <br /> (public.ry p- s <br /> (public • Nate) <br /> PROPOSED PROJECT INFORMATION r <br /> PROJECT DESCRIPTION: TIFF VIEW <br /> Too 1 Stied )�- oning District <br /> This project is a new building or structure. ermined Use? <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: �' PERMIT NUMBE . Ural ' •'(-ss <br /> 0 SEWER it PTIC (n' e <br /> HEIGHT IN FEET: /IMAViesk I i �i + NUMBER OF STO�R_IES: (No ' luding basement) <br /> We : • ••••:lain/ <br /> Shore • (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: •n • ' •I'perrnit <br /> 2 r� TOTAL SQUARE FOOTAGE: (S,•�•' tit ��,, <br /> 2ND FLOOR: 3RD FLOOR: flllin• • 5S) <br /> 15Z , V <br /> -.-.-evie ••«: ,• =ESTIMATED CONSTRUCTION COST: ♦ ♦ -i ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) Q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes la No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes El No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? aYes 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0 Yes 4Q 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) -0 Yes 0 No Li Don't know <br /> 7. Is this to correct a violation? 0 Yes 14N o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -► <br /> 545-112(4/08) <br />