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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 /> 5 1.1�r C S C \- 6.?I)' 'Cs ,Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City, te,Zip) ! ' Deed Restriction; CSM <br /> Lf �l i'a, 1 M/t C�,,, try` Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> A ENT NAME CONTRACTOR NAME <br /> Q t &CJ 111. Site Plan including location <br /> A ENT AD R SS e J CONTRALTO EsS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE Ite approval from <br /> (Q 6 g 7 / 9- i a cab township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floor s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) �y <br /> PARENT PARCEL NUMBER: <br /> 1 ):)-6.1 l CURfl TZONI G: ACREAGE. �Q Eleva ,• .f property <br /> 3 NUMBER °–) II O S p `1-S 'R— I . rq 1 '' fro :i e ,raven to scale. <br /> TOWNSHIP: SECTION: <br /> C C S 1/a: 1J 14 1/a: I rive mits <br /> ADDRESS: (state ,town) <br /> I \A ' I I IN" , ,1 C Vi°`y <br /> _.- an <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> e c�( 1CAo 1� publ' , ate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 11 / <br /> O'f C, L ) 6 i\�j <br /> c) ec.tconing District <br /> ❑This project is a new building or structure. Permitted Use? <br /> "This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUM E Ural a• - <br /> 0 SEWERPTIC ne'` existing <br /> HEIGHT IN FEET: NUMBER OF O F\S: (Not including basement) <br /> We m •,•:*lain/ <br /> S AREA TO NEAREST SQUARE FOOT: • ' '�at8tclment} <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) •, _ <br /> BASEMENT: 1ST FLOOR: on 4 permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes, ` -11 Ma , <br /> r '•e, .aa.--4 <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ —P -�► —P ♦ 0)(and available options. <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? 0 Yes )lo 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? __51-Yes Tlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0 Yes 12.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) ❑Yes CI No lap on't know <br /> 7. Is this to correct a violation? ❑Yes _,1Vo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />