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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME j+ <br /> tAT 1 J _e✓ ■_ kxe--4,i 14 Er Zoning Status; CUP; <br /> OWNER ADDRREESSS (Number,Street,Ciry,State,Zip) V Deed Restriction;CSM <br /> HOME ONE <-1"--L PHONE ��IE MAILADDRES � ��� Variance(# ) <br /> I, 13 - , I El/Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> leC4c V)e.w,! �cti.-{p4,,,.-59 0-4 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS -S of ell/septic <br /> ,,2,19-7 . 4(, 4„` <br /> (City,State,Zip) (City,State, ip) Setbacks <br /> 't )S c-. 3-3 7/.6 <br /> PHONE p E f ite Plan approval from 2:�I,�C�...��� j a plicable township. <br /> E-MAIL ADDRESS E- AIL ADDRESS `` ` ''� II <br /> t y; ,be..,c�St�c 0:kJ . Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> 0 PARCEL NUMBER 0'708r- 3-- 3y-Q & I • 7q frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Mack 1 e_A--,)_, 0 '/4: N Li Y4'/4: Driveway permits <br /> ADDRESS: / 1 / ' I I-r- (st ,county,town) <br /> 7(&2 i 'pr- L-.) I 6-. i tiec4 ,''°"`-,wI 5357_3 Sanitary permits <br /> CSM: IT / SUB iIVISION �j��f BLOCK/LOT <br /> [./ _5* ,A`�MAW, (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRDJCT DE RIPTION: <br /> H— .t -c . (....r.. (c o--. /de <br /> 0 e_C_V U4 ing District <br /> . ['This project is a new building or structure. Permitted Use? <br /> MThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Q Ruraf <br /> 1EWER gEPTIC (new xi g) <br /> HEIGHT IN FEET: ` "`��� NUMBER STORIES: (Not including basement) <br /> 16 ❑ Wet ela/ oodplain/ <br /> Sh d'g•$ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ Ero 'on trot permit <br /> j TOTAL SQUARE FOOTAGE: ,, (sl e , !i-i rbance, <br /> filling/a• ess) <br /> 2ND FLOOR: 3RD FLOOR: 3c1 <br /> ❑ Revien.Lpf,a Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ Q �'t and a it ions. <br /> (Please round to nearest dollar) $ 50 c2c <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes r}o ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? JYes n o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? :Yes n o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ao <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 :4 o ['Don't know <br /> 7. Is this to correct a violation? DYes r o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —. -* <br /> 545-112(4/08) <br />