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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME <br /> Attai"G MFA46w5 fit.,%-s•'0 / ccc- V oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 327' Avy /33 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> COL 7/2- -89, ? Nistf460A4.0,4c/i4i41.4.004/o4fe Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location <br /> AGENT ADDRESS `n CONTRACTOR ADDRESS h/of well/septic <br /> U <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> 0_51 <br /> PHONE PHONE El S.e Plan proval from <br /> �` OW pplic a township. <br /> E-MAIL ADDRESS �/_ E-MAIL ADDRESS <br /> D Flo r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El vation of property <br /> PARENT PARCEL NUMBER. CU ENT ZONING: ACREAGE: P P rty <br /> D NUMBER c,'O —0 - 60-'®n� �I 5. K fr n ge drawn to scale. <br /> TOWNSHIP: SECTION: <br /> iittflA••4 /Z 14: i\J 1.- %%a: Al iveway permits <br /> ADDRESS: state,county,town) <br /> __3,19 4rri _ti✓y /39 S.nitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (■U r IIC,private) <br /> PROPOSED PROJECT INFORMATION AFF-REVIEW <br /> PROJECT DESCRIPTION: <br /> NE'•• get i6/PaL. t 1N5mk.cri ' fin, Lit"- Fe4S.�✓E3 s ►1 Z ding District <br /> . EiThis project is a new building or structure. • Permitted Use <br /> DThis project is an additio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ? y <br /> EWER EPTIC /J ,�Si ©®��Cl 0......=t=> /4 i�ng <br /> HEIGHT IN FEET 0 NUMBER OF TORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT •i1• - •' (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) -permit <br /> BASEMENT: 1ST FLOOR: <br /> 1 © 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbs 'F=, <br /> 2ND FLOOR: I00/� 3RD FLOOR: ©(� } <br /> (�Jl `J ❑ Review • =Lion Survey p 0 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -i ♦ ♦ © and ., -' :,, - OptiOfl$ <br /> (Please round to nearest dollar) 3 O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes Eilo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? D Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none) <br /> 6. Is a location survey required? (see reverse) IYes o ❑Don't know <br /> 7. Is this to correct a violation? Dyes Llo <br /> 0 , APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> ��`J (Continue on Back) -► -■ -► <br />