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--05. Ls <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME t /� <br /> C, �� t I` I S Zoning Status; P; <br /> OWN ADDRESS (N mber,Street,City,State, ) Deed Res is n; CSM <br /> Ci\T A� it cia to ►f i ��Y� 2 Variance( ) <br /> HOME P ONE CELL PHONE E-MAIL ADDRESS CM <br /> I21 q'(0G lkt;,1 V' €v' ''UWO I U 1 i• 105 Site Plan d w o scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and include mensions <br /> A NT NAME Yy�p CONTRACTOR NAME i <br /> 1/1O 1 ' <br /> ' G 'D' , l.s 47t/'C ✓( �' J t0S w Site Plan 'nc ding location <br /> A ENT ADDRESS ONTRACTOR ADDRES of well/se c <br /> 4010 Ci.8ri'gV(et rn Pcf 401D J ►0 m <br /> (g4 State,Zip) ity,State,Zip) Setb cs <br /> PHONE PHONE S� �� ��1 PHO' � 1�� ��5 i 1 ❑Site Plan a P r o <br /> )-45-1–(c14 .1 (gob /11- -1 -lot applicable w s <br /> E-MAIL ADDRESS <br /> rir'i )W' 'i eV2 kt yore ( Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Lt <br /> ElM ` f frontage dra to scale. <br /> NUMBER CVI�2-"1 14"O ` l <br /> TOWNSHIP: SECTION: cam- <br /> C l.i(. _ '/e: E. '/4'/4: SE- 0 Drivewa pe Its <br /> ADDR' ESB: ' (state, co ty,town) <br /> c I ----1t , `7 J [J Sanit ry ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> •. l-> (public, rivate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT D�SC N: sF *£ <br /> LL11}} r <br /> . This project is a new building or structure. :� ` ,` <br /> ['This project is an addition/alteration to an existing building or structure. Y <br /> SANITARY SERVICE: PERMIT NUMBS$:,�1 0�Y1, c , A S <br /> FIEWER EPTIC 177 �L/mil"') LJ/ . s : a <br /> HEIGHT IN FEEtc\t NUMBER OF STORIES: (Not including basement) <br /> J of } <br /> AREA TO NEAREST SQUARE FOOT: : :1411, f <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 9/71 24D 7 "`V � 4, TOTAL SQUARE FOOTAGE: ,'.. <br /> --21'a541.4.-- 245igregl A ''ai(;t YL1G�a(CK-3RD FLOOR: , :, , <br /> EST CONSTRUCTION COST: //]]//1 D}�C d ; ' 4,'.' ;1..7 <br /> ♦ ♦ ♦ ♦ ♦ � > .. a �`a • �: <br /> (Please round to nearest dollar) $ I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres `INo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes NNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? glYes JJ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ZNo <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 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ♦ -. <br /> 545-112(4/08) <br />