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-135o'--4 <br /> ZONING.PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> co;4 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> HOME PHONE /V 6 C ON EE's A LA�DDRESCw g r- <br /> Variance(# ) <br /> .7753g c1 W-0(4/ 7-7 33 qy P(,( ccvo/- cri•2lot c-filu(or' (Cyr-) ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /..-/,Sok 41r) 6.1'�� i—cA Aa.a.j ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> So S c t-. 1-t� / .Sut uO71 E "s�• gert�- ° -(AJLt , b c� <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> ii -M/ is OO Q 5 <br /> CCA — iI.2A.¢ /L 441.2°°S <br /> PHONE PHONE 00 U Site Plan approval from <br /> `i I`( U 3 3/0 3 9,17 .ct 8 / • o b 0 3 applicable township. <br /> E-MAIL ADDRESS <br /> E-MAILADDRESS <br /> Ibeat GI concor:Jiot(-< iirt/(SS (,,,,-1 jm,sctc)ovtQ(Oncovdrr\wive/esS-(v.--P Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> 11 PARCEL 08/0 / 9/(.4f) l oc)O L of frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> �� / or 14: m e 1/41/4: ,51,E j ❑ Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> `/S 8 S Oc/v-c L1---w-- <br /> U Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> a: ,C he_eL /O Ovu[.Lcu.., /0 <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: c k .cil Apr- A >� . • ti 1: t <br /> br h 2, Q. IacvJ._e . Zoom ��� <br /> ❑This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. -,.,:r -< - o <br /> SANITARY SERVICE: PERMIT NUMBER: ARUM <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) , -44 :- <br /> � acnEm s <br /> ! Sho .- k <br /> AREA TO NEAREST SQUARE FOOT: _ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,_ <br /> BASEMENT: 1ST FLOOR: a t. Fa <br /> 4, TOTAL SQUARE FOOTAGE: 4, 4 ,. a, d , <br /> 2ND FLOOR: 3RD FLOOR: - �"k c " ` � <br /> . " -k dl'"' <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ `� 1 UU o • `� nd 1 'I$. .. .i.,---.1 ,:.Y- <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 12.No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 54 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 3No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 'Yes 0 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) loYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes atNo <br /> 10 APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />