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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOM TO PROVIDE <br /> OWNER NAME i k <br /> dIAN, 1S , Z ing Status; CUP; <br /> OWNER ADDRESS (Nu r,Street,City,State,Zip)p ,� <br /> 11k\ N S D y C City_ <br /> v D( lie V ) 1 I t I IA/ Va ea Restriction; CSM <br /> h U ) <br /> HOME PHONE CELL PHONE E-MAIL <br /> 6a-9)11-3533 Gab-aas9 1 be-, I,e , e, (lev, Iic,k)a_ to; , (A. 5 Sif 'Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incl s dimensions <br /> AGENT NAME CONTR CTOR NAME j <br /> L v.S Co , j i o - S. Plan including location <br /> AGENT ADDRESS I I aTRACCTOR A DRESS f well/ ptic <br /> _ SIVIt:.t Ov <br /> (City,State,Zip) (City,State,Zip) ❑ Se a <br /> fe (le • 1\1iw'C <br /> PHONE PHONE a Pla roval from <br /> Ca- ") +5_.--.- co 1 I appli le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Li or ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> I❑ PARCEL 05-Og-3v 9,-s-9.4 1-1 n I- � rontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: 0/, SECTION: <br /> Ill o h'tv OS c ld#o '/s: Al 1.0 %1/s: ❑ Driv:'r: •- its <br /> (sta -,c•unty,town) <br /> ADDRESS: 1� Q 1 1 ,� _ <br /> —n, 1 N $L 0' : Ln v I I f V , 1 I w c 3 S O ❑ Sani : 'ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ' p UU t 111,06 . l (pubes private) <br /> PROPOSED PROJECT INFORMATION •TTAAF REVIEW• <br /> PROJECT D SCRIPTION: pp �I <br /> Reta1 c^n 'tD .Cvdr a A -8 a S x a_c ate`Ii ;i'h 1 'onin District <br /> . ❑This prot.edt is a new building or strucf4e. P i se? <br /> gThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: AEPTIC PERMIT NUM ER: ural Address <br /> ❑SEWER (n <br /> HEIGHT IN FEET: NUMBER OF STORI S: otin din basement) <br /> ) etla • •Aplain� <br /> ��- : orelan•*'-. tachme <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) al <br /> BASEMENT: 1ST F ••R: <br /> It �� <br /> j, TOTAL SQUARE FOOTAGE: j (S <br /> �� filling/access) —c <br /> 2ND FLOOR: 3RD' 00-: 6 d�5 <br /> H Review Location Su <br /> EST ATED CONSTRUCTION COS.. ♦ ♦ ♦ ♦ ♦ �r and availabi <br /> (Please round to nearest dollar) t� o o( . �� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't kno0 <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? Q Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L 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 ►1 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes W No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />