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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO P OVIDE <br /> OWNER NAME <br /> OWNERADDR S (Number,Street,c rate z \ Ak — ❑ Zoning St s;CUP; <br /> 29 A-Yty' p) ' l Deed striction; CSM <br /> P" 3 '� -) \(k1) 1 ~�� ari ce(# ) <br /> HOME ONE CELL PHONE E-MAIL ADDRESS <br /> s,Id-63Gi-'17o•i: F 0 0-71 2.1175 5RAtit'f- 91 Li (ANI0CA4AK .14. Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> 3Rds-DLir b iLL k,1 Oft k -t c Lo-, ( NJ. S.e Plan including location <br /> AGENT ADDRESS CONTRA6TOR ADDRESS f well/septic <br /> 530.9 P- ' ' v 4/ y' <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> MAcJt�a W -7t vx// 53521 <br /> PHONE PHONE .1 ❑ Site Plan ap val from <br /> &CS- 2-1-3-- SQ so applicab o hip. <br /> E-MAILADDRESS E-MAIL <br /> INZA01- •1 LLB W eCC-{Atz � -t ❑ loon ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: P P rty <br /> ❑ =ail 0`f'2/o509-202 8890-(Q A- ■ CV yr vs) 5 t frontage drawn cafe. <br /> TOWNSHIP: S 1%: V 141%: ❑ DfIVeW ermits 0iR Kp <br /> ADDRESS: ````''JJA�YY (Slat ,county, n) <br /> CSM: LOT 9 !-4 w y A T L5'�"c.C�k--D'•SUBDIVISION\IV( 5-571 I BLOCK/LOT <br /> ❑ Sanita. permits <br /> 0515/ Lot 1 (pus c,private) <br /> PROPOSED PROJECT INFORMATION <br /> TAfF REVIEW <br /> PROJECT DESCRIPTION: <br /> 2J)XVj Cwt .c N c-- R oning District <br /> A This project is a new building or structure. Permitted Use? <br /> ❑This project is an additio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rura ' .-' es. <br /> 0 SEWER SEPTIC (new -xistin. <br /> HEIGHT IN FEET: NUMBER dF STORIES: (Not including basement) <br /> C)`--rf E7j s. ❑ WetlandfF plain/ <br /> Shore! d (attach <br /> AREA TO NEAREST sQUAFE FOOT: <br /> (Outside dimensions including unfinished area,attached gar ges and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: f/ ❑ ErostonCont r. permit <br /> ��'7 l TOTAL SQUARE FOOTAGE: j (slopes,d : ■ • .-, <br /> 2ND FLOOR: 3RD FLOOR: ( I - � illing�a SS) <br /> ❑ Survey CONSTRUCTION COST: and a I able o ptions.(Please round to nearest dollar) —0. —P. ♦ "∎ —0. —.• $ l 2 77 <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000'feet from a pond or lake? 21 Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes SI No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 21 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 3 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 SNo ❑Don't know <br /> 7. Is this to correct a violatio ? ❑Yes 211No <br /> OAPPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ ■ —► <br />