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-- 4 c) _ 0-1 5 = I o-l-5� (' <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMS TO PROVIDE <br /> OWNER NAME <br /> Br 41 c e g ( e C rh / e r oning Status;CUP; <br /> O NER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> f Z 81 13;,�-�CELL 1Z� v e rr�r Q /Gf �l1 $35�' Varia ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6c' '7 _ 6 OOS ite Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO NT CTOR NAME <br /> 3011 a 7 o/Sc 4 . - c: 1 /p r Sc` sV ,ec, , L ...,- <br /> qy e Plan including location <br /> AGENT ADDRESS /� CONTRACTOR ADDRESS o of well/septic <br /> f 3 sy /3,, NCO/ i 3 s`y eel L f 'ei, <br /> (City,State,Zip) Q (C' ,State,Zip) Q�et6acks <br /> V PHONE PHONE • -it, .proval from <br /> (,OS " 4Y'' Sd 2 S .,O$ , >c - S° 2 -- .le . nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Flo s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) <br /> PARENT PARCEL NUMBER: CU E ZONI G: ACREAGE: 4.4. levation of property <br /> 1:1 PARCEL <br /> NUMBER 07/2,0 $ Z 8 515-0 /4 - , frotage drawn to scale. <br /> TOWNSHIP: // SECTION: <br /> ,?eer'Ii Q/Gr j 6 1/a: /0 ct) 1/a1/a: A) (V -P-1dye mits <br /> ADDRESS: (st , o ty,town) <br /> /Z S/ i c1 r„ 'b' <br /> anitary •- •• its <br /> //CSM: LOT SUBDIVISION BLOCK/LOT <br /> ca ubli ,priv•te) <br /> g 1 <br /> PROPOSED PROJECT INFORMATION STAFF R IEW <br /> PROJECT DESCRIPTION: <br /> /a x i? O (,ar-,Jeer S e✓�� 8.r Qi71rt�District <br /> EaThis project is a new building or structure. Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT N UM Ur <br /> ...421T1 <br /> ❑SEWER EPTIC VII e <br /> HEIGHT IN FEET: _ NUMBER OF STORIES: (Not including basement) <br /> 1 Z / i Wetl-n• .• ilam/ <br /> AREA TO NEAREST SQUARE FOOT: '= ' (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1S ���� � ajn'nrt, <br /> ,, TOTAL SQUARE FOOTAGE: 4, slopes, a +. + * e, <br /> 2ND FLOOR: 3RD FLOOR: f fllltn• t <br /> U Review Location S <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available oPPtio <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 IA No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes afNo <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 ai No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -i -► <br />