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G ,: <br /> ZONING PERMIT AP ' LI ATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> C ad l lam, tit ki t,neJ <br /> Zoning Status;CUP; <br /> -.L OWNER ADDRESS (Number,Street,City, te, i <br /> (l` 3 46, t-�a n n er v i ��� id cic� er-o� 1� 6353 Variance(#ICtion; CSM ) <br /> HOME PHONE .., PHONE E-MAIL ADDRESS <br /> 0'3 813 39.4 6i5?36/5 55 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> N • it- ' .n inc ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of , - ='tic <br /> (City,State,Zip) (City,State,Zip) ,, etbacks <br /> PHONE PHONE ite Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 1 loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: b-� levation of property <br /> PARCEL a 511 a64 85ba-o V1. , Ex 3 , rontage drawn to scale. <br /> NUMBER I"�TOWNSHIP: SECTION <br /> (,ui i t b Y%: '/a'/a: jjN ' Driveway permits <br /> ADORES$: (state,county,town) <br /> 34-6 �annierut Ile Fci -erfbn WI 5353 `T anitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5 �01 1-. ....x a ) ning Distnct <br /> This project is a new building or structure. ' -.. ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMI U R ` - <br /> • -- 411"- PTIC ( -w/existing) ';4 <br /> EIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 )441., din lain/ <br /> AREA TO NEAREST SQUARE FOOT: ShOfel ttaGfiment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ■ <br /> BASEMENT 1ST FLOOR: ^ <br /> •. "sionCori + R=relit <br /> 10 x` (� C, ,l TOTAL SQUARE FOOTAGE: lop" Gi e P= *'; <br /> filli 14 <br /> 2ND FLOOR: .� 3RD FLOOR: / ' J <br /> ESTIMATED CONSTRUCTION COST: X l l�(J <br /> Review 1 •+• Survey <br /> (Please round to nearest dollar) <br /> ♦ ♦ ♦ ♦ —► —► and ava' e . •bans. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 1Et 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'? —la,Yes 8'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) ❑Yes) No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4/08) <br />