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��\,, x - (3-757,S 0-74 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �� <br /> wrhao RE3�(uFib�r,s -t,clty State,a)byiwlk , k Zoning Status;CUP; <br /> 9 �1 (i.� �{ 2 Deed Restriction; CSM <br /> HOME PHONE ELL PHONE E-MAIL bbA DRESS �� 5 3 yl Variance(# ) <br /> S ❑ Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> i4-o v 5 960-71444- 4NSTliuc-no P a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Hof well/septic <br /> II 5-1 N.04, y , .- y s nvt4 E <br /> ,State,Zip) (City,State,Zip) Setbacks <br /> ?1{16_,V dig l*r 53ro j ""PHONE -- PHONE Ite Plan proval from <br /> 177- -o19 U plicable t sip. <br /> E-MAIL ADDRESS EILADDRESS <br /> For plans to scale <br /> .ern 1 .4 Ala <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 1°0 Elevation of property <br /> Li PARCEL <br /> UM EL N co 9-17310-, •` I _Z �'�1 •ntage drawn to scale. <br /> NUMBER t4 � 7 �m �1 <br /> TOWNSHIP: SECTION: rlVeWa a its <br /> e py� 1 `-I IA: S /aYa: state ,town) <br /> ADDRESS: <br /> / !•L au. A, `i — •, Sanita ,•ermits <br /> CSM: • SUBDIVISION BLOCK/LOT (pu• IC,p 'vate) <br /> PROPOSED PROJECT INFORMATION STAFF -EVIEW <br /> PROJECT DESCRIPTION: <br /> SG>►geFN PO t#14,0 /776N /1--) X ) Zoning District <br /> ❑This project is a new building or structure. Q-permitted Use? <br /> p This project is an addition/alteration to an existing building or structure. `\ <br /> SANITARY SERVICE: PERMIT NUMBER: --ALAI ur- ' •' -- <br /> ❑SEWER 14 SEPTIC (ne, /exlstin•' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ) ) A\,,- r etlan•( ,•.-�dplam/ <br /> ll Sho e an (attachment) <br /> AREA?O NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: frost <br /> a-2-14 J ,l, TOTAL SQUARE FOOTAGE: ,Ir l . tsturbance, <br /> 2ND FLOOR: 3RD FLOOR: ,./, filltng/a S), <br /> --- 7Z i:l eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q I y d 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? ❑Yes a No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No gj 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? pYes ❑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 rallo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Et No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -■ —► —► <br /> 545-112(4/08) <br />