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- ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROV <br /> OWNER NAME <br /> 1 I ''__ <br /> Ni �Qc-k4 1'4CC. <br /> ❑ Zoning Stat , CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> i84Z c.d./woe-AA-gm ed riction; CSM <br /> �GI A?OI KIA'tr►t'C (,t)' S �S 35LO a • ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ro8-- 843 G e 0 1 <br /> e Plan drawn to scale <br /> ( AGENAGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> (,,,,,, <br /> TNAME CONTRACTOR NAME <br /> 1$1 4c k }-�or►�te 5 L�1C) A'Y��"('S O 7�) 'e Plan including location <br /> AGENT ADDRESS CONT-•CTOR ADD SS f well/septic <br /> 664z <: e O ,- R� p <br /> tf\ ity,State,Zip) , / (City State, p) Setbacks 1 J 0 <br /> MA2onikevf -Q 53sto T© rea ' � <br /> PHONE ` PHONE ❑ Site Plan approval from \M/11'x. <br /> TR-16V 't%o ') 84s-6,411 cdTT' ((gC,5) s"7-2-1"IS( -pplicabletownship. �/ <br /> E-MAIL ADDRESS FA y(6,0:5- 6 ADDRESS "�h <br /> 'r Ay(tob-6 L B •Ic, ^ Goo C r oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑ NUMBER 09 o4o- 2-61-953° -2 A - J E. , /,4. frontage drawn to scale. <br /> TOWNSHIP: SECTION.r �e --., !_ �` <br /> /Y)AZOrwo1At v 28 ' — ' : N F %a/a: _ I-- ❑ Drveway permits I��(I S <br /> Al e8 <br /> ( tate,county, town) <br /> �g42 CC -epen )" (�a l-d YVN4 66e, (N•5 53 SLO II Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT I ry p <br /> 4 3 I (p .lic, private) <br /> PROPOSED PROJECT INFORMATION 0q <br /> PROJECT DESCRIPTION: , <br /> N e w 4o vvv.-c. i'../-- lihi A . ,;,!'.7.t:(4-. 1.051",440-,' <br /> . $ his project is a new building or structure. } r . <br /> CI This project is an addition/alteration to an existing building or structure. ."" ' 1• <br /> SANITARY SERVICE: ❑ "- <br /> PERMIT NUMBER: � �� „t -' <br /> �J reel <br /> ❑SEWER .SEPTIC � �' _��� :-q� <br /> HEIGHT IN FEET: hr <br /> 1 NUMBER OF STORIES: (Not including basement) , i �. <br /> e • •a�• : <br /> AREA TO NEAREST SQUARE FOOT: f- i. :V ai <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) • `4 <br /> BASEMENT: 1ST FLOOR: <br /> 1 598 'a q Ci 2_ ,� TOTAL SQUARE FOOTAGE: 1 ' ',.,:4--4/....+4 i e e r°":33}1°'. ,F= <br /> V a <br /> 2ND FLOOR: 3RD FLOOR: ^r�O l'-'t�''�Zi r , 4# 1 <br /> G�J ❑>RevsLocai fSui . ` <br /> ESTIMATED CONSTRUCTION COST: d d a end able o (ions i , <br /> (Please round to nearest dollar) ��(� to: Ec <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Cl/Yes ,QNo ❑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'? XI Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes $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 ' 'No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes JgAio <br /> c c ^Q 8 �— APPLICATION MUST BE SIGNED <br /> / / (Continue on Back) -► ♦ -1 <br />