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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> J.e5S- Q e r oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 54 6 L ex;ngi..•r 04 a r eooh wT 53 575 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Cot-'1 3 It-45 71/ ,S derrr e to w 1i e•L lfi►,,of rasitrgan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n(-ore WI,rate-- Erato . 14.old', ❑Site uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ptiC <br /> 6 Sii G 5 iieiiW Real C, jo Same.4er goal <br /> (City,State,Zip). (City,State,Zip) Setbacks <br /> ✓ <br /> r,,:altc}.n t.,1 53 V,2 eh:stilc+a'7 4 5356 2 <br /> PHONE PHONE ❑Site pproval from <br /> 6o$- S5C-1401 6dis-153c-itol appli ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> e/70 ;5Ie(,eiQerXo(six411S a.os eh. ire( ) e•�tore.1.�'115 ael5ot [�ll�r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: eation of property <br /> y <br /> 0 04// 1a/ it� © R' I e NUMBER <br /> 4$3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: *11 t <br /> 'f)et�tep 5flr 3 2Tt b' 1/: Vk '/4'/<: ke eway permits <br /> v ADDRESS: �S (state, county,tt!5 <br /> 11 / �Akv.,leA � Or ❑S.nitary permits <br /> CSM: T SUBDIVISION BLOCK/LOT <br /> gokos 1399% 1 publt•, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW„ <br /> PROJECT DESCRIPTION: <br /> S oning District ` _ <br /> This project is a new building or structure. ] ; { �t ed Use?6 <br /> ['This project is an addition/alteration to n existing building or structure. . <br /> SANITARY ■ PERMIT UMBER: l� :' - Address--,!„-, <br /> 1P _ <br /> ■ - . I. ic-e S (new xistiing) <br /> HEIGHT I ,�` `�,�,� NUMBER OF STORIES: (Not including basement) ,_,,,, �--- <br /> 3 0 f Bolt- C'/ S 2. 020 errand/Floodpiat * ;ty c <br /> Shoreland (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: ❑`Frost• • trot permit <br /> Q[ ici L L �� • ( le • rbance4, 4, S , <br /> ' fi •- -re -i. <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3 3 Y• 7 5 ® 'e■tew Location Suave <br /> ESTIMATED CONSTRUCTION COST: $ and availab :'tons:- <br /> (Please round to nearest dollar) ♦ ♦ "■ ♦ ♦ ♦ �P 3t 51 q6G,o0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes UNo ❑Don't know3. <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ElNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ®1'es ❑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) Elves ❑No ❑Don't know <br /> 7. Is this to correct a violation? [Yes EriN o <br /> AIAUST B- ED <br /> (Continue PPL C on TION BacMk) 9 E SIGN-► -► <br /> 545-112(8/09) <br /> I <br /> • <br />