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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to W.b•App # <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNS ME <br /> 101-06e./. /4/05}Yb...4.45�c Zo . g Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Jf 7 y �;v� 4...N,` edy-cc-1v•n 4/-x 5 3s 3 L/ aria ce st#riction;CSM/HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> CO X r a'.I., 18C1-7 e,(Au sty_ $4.. r►«•1.ca rf Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 5 Cdt. jc.c.NJ-L ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE Site Plan ap al from <br /> applicab ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accossdano.co.dan..wl.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levation of property <br /> ❑ PARCEL 4/I 117p frontage drawn to scale. <br /> NUMBER ooa/Qsfal csYS 7.1/0 ,{ 1. O <br /> TOWNSHIP: SECTI ` <br /> AM:�h '/.: WA: � riveway permits <br /> ADDRESS: � f.'....., 1� 0 �� t� 0\ (state,county,town) <br /> CSM: LOT SUBDIVISION )/vBLOCK/LOT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /f/a A.r'6L o.1304„.Lt t.. \J I L sr- + Q It_ ` Ming 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 NUMBER: J 0/6 ® •' S <br /> ❑SEWER ,SEPTIC •--. O ow ;-r 4 - i +) <br /> HEIGHT IN FEET: / [ / NUMBER OF STORIES: (Not including basement) <br /> r. <br /> -- " Sh• = • (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BAS MENT: fr_-' 1ST FLOOR: ❑ ErosionCcm E'a pem" <br /> C7 �►� AFT) d,;�y( Q 7( 4, TOTAL SQUARE FOOTAGE: j (ssloppes, • --.. •- •-, <br /> FLOOR: 3RD FLOOR <br /> . ,TT Review Location S <br /> ESTIMATED CONSTRUCTION COST: —II. ♦ . and available options. <br /> (Please round to nearest dollar) $ 23��X7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes kr No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Ni No ❑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? ❑Y No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le ve 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? WrYes YNo <br /> //O k L( 3/3 APPLICATION MUST BE SIGNED <br /> 545-112(4/08)(4/08) `I/ (Continue on Back) ■ -, <br />