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ZONING PERMIT APPLICATION www.countyofdane.com SUPS EMENT to Web-App # <br /> 1 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN 9iR NAME <br /> OWN V4(.1. ESS Number t V--"ete Zi C G L. b 1," �Z Wing Status; CUP; <br /> ( P) e d Restriction; CSM <br /> HOME ONES '�C�LL PHONE + J M ILADDRESS �� ��� a ance(# ) <br /> „1. 37-6,7 7 ,Q: -77U -c�-Zoa d� lu fa c�, atzoo. C_oc l <br /> ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONSRACTOR NAME <br /> ��j \1 . z,,-. )4- v .):A t .v.- to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> - <br /> (City,State,Zip) (CI State,Zip) Setbacks <br /> PHONE PHONE"C., S.e PI pproval from <br /> 0 - .L C1 It -/ q 1 c,,,'' plic I ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT NING:, ACREAGE: levation of property <br /> ['PARCEL rontage drawn to scale. <br /> NUMBER a607-0 rbosio I <br /> TOWNSHIP SECTIO . <br /> S ��' „1, ��� /V ' : ! E '/%: /1 1 briveway permits <br /> ADD `i3� t / j(state,county:town) <br /> CSM: LO7 SUBDIVISION BLOCK/LOT ., S-nitarypermits <br /> blic,private) <br /> f <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DES IPTION: <br /> cf _ tip IL'i .+sZ� 40(„/ } .-+�_ `t.- ' n �4 / .Wing District <br /> �.J <br /> . This project is a new building or structure. • P rmitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ r Address <br /> EWER EPTIC it `� -, e'C " c 0 a 1 (n existing) <br /> HEIGHT INN B�EET: NUM ER OF STORIES: (Not induding basement)0)`t'� � Q ❑ d/FI plai <br /> AREA TO NEAREST SQUARE FOO ca I aP Shorela (a merit) <br /> (Outside dimensions including unfinished area,attached garages an above g- e decks or porches) <br /> BASEMENT:, 1STFLOQR: frE C ErOSionCo of permit <br /> 4, TOTp Foom l0,/ (slopes, turbans, <br /> 2ND FLOOR: 3RD FLOOR: `0 �J 0 <br /> filling/a ss) K\ip <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> and available options. <br /> (Please round to nearest dollar) "♦ "'� '♦ '∎ 'o- $ \3 , .� - `$�V <br /> 71Qoc , gcA i'4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Q1'es ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [Ees 12 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes to <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none) <br /> 6. Is a location survey required? (see reverse) ['Yes ./ o ['Don't know <br /> 7. Is this to correct a violation? QYes Ellgo <br /> 54 i APPLICATION MUST BE SIGNED <br /> /lJ\ (Continue on Back) -e• ♦ -4.-5112(4/08) t, <br />