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LC/ti. 6o SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> -c4---F- Ire_L,1 ci Zoning Status; UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> I <br /> Deed Res ion; CSM 6oS S oncka,)e_n 0( . n rfa.rie ,W--\\ q c Pft Variance( ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS 1 1 <br /> 6109-$3-7-S9ar6o8-1Zo-Lo9$ ---r • irekancl '�Ask 3v11. (o') Xi SitePlandrawntoscale 2 '^ <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions G—iCJ <br /> AGENT NAME At f i i CONT O NAME G <br /> u9v9 &-oltur.s '(�xii... /o^ ,I 44:9 er/,/ekv gSite PI ' luding locatio <br /> AGENT ADDRESS v CONTRACTOR��ADppRESS ,� / of well/ ptic <br /> LIS `j ( I I vl u 4 I`''' . <br /> (City,State,Zip) (C' , ate,Zip) 9 Setback/ <br /> 7 Flo 104k lU ?/ _j�, <br /> PHONE PHONE / ; .$ite Plan '.• m <br /> bog_ 219_ Co applicabl to s ip <br /> E-MAIL ADDRESS E-MAILADDR <br /> r b1/U5 ADDRESS a.v k-cr, (lei- ■ Floor plans Vialle <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation o r <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: rty <br /> D PARCEL 4'1 s, d/ frontage dr� to scale. <br /> NUMBER <br /> TOWN IP: al SECTION: <br /> NOM 0 r<<e 2 '/4: TSJJ %%: is - Driveway Vie. <br /> ADDRESS: (state, cown) <br /> Lof 3 CSC x9315 52,91 -tvvi (0.1 <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits /- � I <br /> 0 3 g 3 (public, private) f✓ /lam re* <br /> PROPOSED PROJECT INFORMATION STAFF <br /> PROJECT DESCRIPTION: r._ <br /> Ago AGO Ca+nS{(udt 1,r) ❑ ZonixV'Sistrict <br /> . his project is a new building or structure. .Pe Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ���// PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ASEPTIC /3— Z o r t° — 6. D 2C/ ng) . <br /> HEIGHT IN FEET I NUMBER OF STORIES: (Not including basement) ❑ <br /> AREA* 1 e / I.. s •aa , 'Ili <br /> NEAREST SQUARE FOOT ShOrt31a PY CO <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> ❑ Erosto- ° . -. permit <br /> BASEMENT 1ST FLOOR: ' • _ ` s <br /> ( j .l TOTAL SQUARE FOOTAGE: 4 ( <br /> 3/ D 3,d° 4" iltllin•. -•._- ) <br /> 1149-FLOOR: a ,BD N.S p M 3RD FLOOR: <br /> '] <br /> Y D / 52S ❑ Review L tion Survey t <br /> ESTIMATED CONSTRUCTION COST: �1 ^and I _ i.ns. <br /> (Please round to nearest dollar) -4 ♦ ♦ ♦ ♦ ♦ S S (A- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Aes Li No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L2610 <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 R1 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -i —. <br /> 545-112(4/08) <br />