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/. .. c .0 x D ---7-S-7' S' ------ ) '--fr 0 $ <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> %_O/T(e G7 f v i!05 Zoning Status; CUP; <br /> o ER ADDRESS (Number,Street,City,State,Zip) _ eed Restriction;CSM <br /> 9-$7/ f--€ ,,,k t'rt,r 'r Co e Gre v-e 1� .53 )-7 variance(# ) <br /> HOME PHONE CELL PHONE MAIL ADDRESS <br /> • '(C " Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION .nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS , f well/septic <br /> (City,State,Zip) (City,State,Zip) ._C etbacks <br /> PHONE PHON Site n proval from <br /> _ appl. a township. <br /> E-MAIL ADDRES E-MAIL ADDRESS <br /> ,door plans scale <br /> PROPERTY/LOCATION INFORMATION (http://acctessdane.co.dane.wi.usl) <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: Elevation of property <br /> Ll NUMBER 0(5-07`/ O2-93q/60-0 X -l frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Col -e 6 rove 2-7 1/a: SLv 1/a'/a: S',✓ rive y rmits <br /> ADDRESS: (Sta unty,town) <br /> 7-7 FC i'h irl•r-6) 0r Sanita . •rmits <br /> CSM: LOT SUBDIVISION BLO •'-•T <br /> O —� (publi , o rivate) <br /> PROPOSED PROJECT INFORMATION STAFF - VIEW <br /> PROJECT DESCRIPTION: <br /> lr� C,c✓'4 2 / ning District <br /> l <br /> ?This project is a new building or structure. <br /> j; Perrnitteal Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBE Rural -'. .° <br /> ❑SEWER SEPTIC �/ (ne /existing) <br /> HEIGHT IN FEET: /� NUMBE OF STO IES: (Not including basement) <br /> /( ) 14, ( ar , etla gi.75104.E. .in/ <br /> A TO NEAREST SQUARE FOOT: <br /> S . - (- -ctiment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: rOStOnCOtIiTnit <br /> 1- - Q 4, TOTAL SQUARE FOOTAGE: I (sloes,disturbance, <br /> ;naattaoya.' <br /> 2ND FLOOR: 3RD FLOOR: Ii ^6D ( ry <br /> ESTIMATED CONSTRUCTION COST: �/ ( eview Location Survey <br /> (Please round to nearest dollar) '♦ "� ♦ "� "� ♦ �/�� and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No Li Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes .- 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? ❑Yes .allo <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 UNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -o. <br />