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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUST ER TO PROVIDE <br /> OWNER�C NAME 4 � Id��1'I a � o✓'N oning Status;CUP; <br /> OWNER ADDRE S (Nu r,Street,CI ,Stat ,zip) Deed Restriction; CSM <br /> CyyGG Q 1 �O✓� _ Variance(# ) ^ <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Ay' <br /> an drawn to scale 4)/ , <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG T ME CONTRACTOR NAME -f- <br /> I�o .�1 r-e'I e r ❑Site Pla in ing location 0 <br /> AGENT+ ADDRESS i CONTRACTOR ADDRESS of we tic q-,`_ <br /> /(City, Pr11(State,Zip) / (City,State,Zip) etback Zip) s /-7 <br /> PI-DNE /-� Q PHONE Si la approval from ' P„7 <br /> G j L�� b° C� pplic le township. .p <br /> Ai <br /> E-MAIL ADDRESS E-MAIL ADDRESS 'S <br /> 1. l / L oor plans to scale /, <br /> C., r t'e '�tr� JcO1t�CacVpa{�'S� <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: EI of f property <br /> ❑NUMBER c'1 a 17 4 8503 Q A I J Ont a drawn to scale. <br /> TOWNSHIP: SECTION: <br /> fly a,))-1, p n /J 1/4: 5 '/4'/4: D veway •-rmits <br /> ^\,/ ADDR ^ (state, : n , own <br /> CSM: LOT SUBDIVISION BLOCK/LOT -nits •_+ its <br /> (public ate _ <br /> v L <br /> PROPOSED PROJECT INFORMATION <br /> Z FF • EVIEW <br /> PROJECT DESCRIPTION'I /,.r.: Si-0 St -4*. Pa,.,- )4)4; <br /> District <br /> his project is a new building or structure. 1. rrnitted Use? <br /> UThis project is an addition/alteration to an existing building or structure.4 SANITARY SERVICE: PERMIT NUMB R: ural Address <br /> EWER r 'EPTIC (new/ <br /> HEIGHT IN FEET: NUMBER OF STO S: (Not including basement) .i <br /> q )- S - and •,•plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shot*: (attachment) <br /> (Outside dimension including unfinished area,attached garages and above grade decks or porches) Il • -'•nContr• permit <br /> BASEMENT: 1ST FLOOR: 4, TOTAL SQUARE FOOTAGE: 4, (slopes, •: i urbance, <br /> Min.• . cess <br /> 2ND FLOOR: 3RD FLOOR: In— <br /> ill Review Loca••. -1.; ey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available option-, <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes EJio ❑Don't krlow <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes Erin ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [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) Ekes Eio ['Don't know <br /> 7. Is this to correct a violation? [Yes alo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />