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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTO ER TO PROVIDE <br /> ,Of rionSiTA;itretk4` - 'd(4 in g Statu s; CUP; <br /> Z OWNER S (Number, city,�a te,zip) eed Restriction; CSM <br /> IJ50 VAnnl�. t . &,Ln. r� c S35 1 0 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (or6-(f(0ci_a03 'e Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ( S 14 c-t CU I- 2. K-NC-T (Yt 4 �o (Y(/1 • Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w II/septic <br /> CA°3157^4 hJ2._ <br /> City State,Zip) Ci ,State,Zip Setbacks <br /> Sk 01, 35142, <br /> PHONE PHONE D Site a royal from <br /> 2Y Z -q 3 q - ,ae)(3Q) applica wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SLt{421-1-r(;-),-ft, .rh9 foi)( ( % i( C'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> 1=1 PARENT PARCEL NUMBER: CU ENTZQNING: ACREAGE: 1 evation of property <br /> PARCEL / ` // /� frontage drawn to scale. <br /> NUMBER O9// ) / d iii Q �'1`5 0 <br /> / nS*o SHIP: SECTION: <br /> i6 r I tie.- 1. nut-) %%. ( 1/v]' <br /> D ' away •-mu ti <br /> A DRES s te,cou ,tow, <br /> Sanitary permits <br /> CSM: LOT i ko fw i Wad BLOCK/LOT (public,private) <br /> 04, <br /> PROPOSED PROJECT INFORMATION REVIEW <br /> PROJECT DESCRIPTION:s_T..-• <br /> VICZ‘nir District <br /> . ' This project is a new building or structure. P fitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ` ' ••teas <br /> ( 3 2_0 I (o -00 2 I Z ng) <br /> EWER �EPTIC � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> 1 1 11/ 5 1 • Wetlan. ( .•• •-in/ <br /> REST SQUARE FOOT: <br /> S • (attachment) <br /> (Outside dimensions induding unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: jj (� l� Enos • permit <br /> I (n (el 1 1 ( _9 �7'SC 9 ,, TOTAL SQUARE FOOTAGE: , (' •• disturbance, <br /> : Y W ��TJI filli .1 .,._A. ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> :V 2. _ 0evlew Location Survey <br /> ESTIMATED CONSTRUCTION COST: --► ♦ -► ��S n Q Q and available opts <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? DYeslo - Don't kno <br /> 2. Is there a wetland or floodplain on or near the property? Dyes o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? :Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes EINo <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) es IVo ['Don't know <br /> 7. Is this to correct a violation? Dyes 1Vo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aros) (Continue on Back) —► —+ —► <br />