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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Michael £vi CI,.Son Zoning Status;CUP; 3 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) � tt�� Deed Restriction;CSM <br /> x{00 Mewl pv1/4,16 stn O t a 1l 64/ w t 5311 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> We(vx6-LI 573 "' sz.rrso z.?. e - 6,00•wn► l;vi Site Plan drawn to scale 0 <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ■ L <br /> d Site Plan including locatio 4 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic • <br /> 2 5— <br /> (city,Sea,zip) (city,State,Zip) �]Setbacks 2- 0/20 /i <br /> PHONE PHONE Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS �f <br /> I.1 boor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) / <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: �EI @VatlOn of property <br /> ❑PARCEL / /D -61c/ it 7 4 p 3 I/14 (,ZS) frontage drawn to scat . <br /> TOWNSHIP: SECyp N ,!� <br /> •l3 <br /> TOWNSHIP: . Grove V - %: /v t= '/%: AI U ,Drivewaype <br /> ADDRESS: <br /> (state,county <br /> 4100 Mar :Am 5 heehv2 I, ;, <br /> � ;j-..,•�..-. permits <br /> — ! 1' <br /> CSM: LOT SUBDIVISION <br /> 4 LLG fit• 15 ,BLOCK/LOT <br /> - private) <br /> PROPOSED PROJECT INFORMATION "A ° r e a ' 1,`9 , <br /> PROJECT DESCRIPTION: /0 f ( -/ L j� F �, ` ∎ !e n sr <br /> ❑This project is a,,,,,.,..',;' g or structure. '�� '' <br /> This project is ., iti•• ,Iteration to an existing building or structure. r` #s#- <br /> SANITARY SERVICE: PERMIT NUMBER: x <br /> IEWER REPTIC 'srf, ` ' ; <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (Not i/n/duding basement) # <br /> AREA TO NEAREST SQUARE FOOT: , � � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4 •�_ , -_,,M,---,.� <br /> BASEMENT: 1ST FLOOR: / as�� �� <br /> 4, TOTAL SQUARE FOOTAGE: a a, <br /> 3 " a w <br /> 2ND FLOOR: 3RD FLOOR: ( s , - <br /> . <br /> ESTIMATED CONSTRUCTION COST: ar= '-'7 0(Please round to nearest dollar) -► �D Q � , ` �� ' ' <br /> p, ,'eve_ 3 2 4 /6 < D Sti r V(')/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes NINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑[EYeslo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#____7_____) (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 /> 545-112(4Atl) t 5-q, 5 0 (Continue on Back) ■ ■ —► <br />