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i 0 4 OV <br /> ZONING PERMIT APPLICATION www.countyofdane.com SURPLEMENT.to;webApp.`#'. <br /> PROPERTY:OWNERlNFORMATION <br /> j13 /r)N E `� P I T -np �./_1. I,n, ''� CUSTOMER TO PROVIDE <br /> "2 �r 1 r n ' r 1(r I r '0 Zoning Status; CUP; <br /> OWNER ADDRESS (Nuts Str et,Ci ,State,Zipk Deed Restriction; CSM <br /> 5 y11 VIg !'I Gt e <br /> Variance(# ) <br /> HOME PHONE n t ' CELL PHONE E-MAIL ADDRESS <br /> 11a is ►gc64 I . .Y OS.1 a niic ( I•� Site Plan drawn to scale <br /> AGENT INFORMATION CONTPJ CTOK INFORMATION",° ;} , and includes dimensions <br /> AGENT NAME CONTRAC O NAME <br /> 3 e 2.ie I {0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> IC)a Uv0o bifi C 5e- <br /> (City,State,Zip) ( ity State,Zip) ❑Setbacks <br /> PHONE Q.u-nC,k-te t kiv\ 53ER <br /> 'PHnONEp C ❑Site Plan .•• . f, .n <br /> LPL Q rJ ] L i a J-1 applica• - -ff.. <br /> E-MAIL ADDRESS E-MAIL ADDRE <br /> al G Lids • re_-}- ❑Floor plans to scale <br /> ;PROPERTY/LOCATIONC INFORMATION hti •//accessdane coda ne w►,us - tj; <br /> (_ U n `"_" `` []Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE. <br /> PARCEL O80$_o�3-ai33.3 1Z-1_ A I . � frontage drawn to scale. <br /> NUMBER 0 T <br /> TOWNSHI SECTION: <br /> by ri 6 /a. ,,/4. ❑Driveway permits <br /> ADDRESS: 1 _, (state,county,town) <br /> ❑Sanitary permits ^ <br /> csM: 7T7 SUBDIVICON BLOCK/LOT ublic rivate . f'/ <br /> ih • (p , ) <br /> PROPOSED PROJECT INFORMATION rl STAFF REVIW E <br /> PROJECT DESCRIPTION:, .� i.i <br /> SF �{: Zorirn stnct <br /> In This project is a new building or structure. Permltt F` see `` <br /> ['This project is an addition/alteration to an existing building or structure. _ ' 1 <br /> SANITARY SERVICE: —® T x x r: <br /> PERMIT NUMBER: I n '\ I , _ RUfalAddreSSiti <br /> EWER >qEPTIC \b-a D I LP- b Y l.0 I " e`xtshng) 3�_ <br /> HEIGHT I EET NUMBER OF STORIES: (Not including basement) t S <br /> U rq) 1.. <br /> ❑ <br /> (,r \ wetlar]d/F oo•p <br /> J ' Shofelandi; ,C• "e <br /> AREA TO NEAREST SQUARE FOOT x : <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) l E l "-i. f <br /> BASEMENT: 1ST FLOOR: i ® rosronCo • <br /> p�ermrt ate <br /> l l l�(h\�`I11' i vrip i 4 �'l' TOTAL SQUARE FOOTAGE slopes ."t ��e e 1 <br /> as (•,.� ► 3�q� „ .Pf ,,,<<�.►-� <br /> 2ND FLOOR: ' 3RD FLOOR: -, ' ' ..,,� { ����� ��;y� <br /> I(I�� '' �,�'�'V� Revlew�L}ocatlbn.SUrvey <br /> ESTIMATED CONSTRUCTION COST: ' ' � <br /> ( ) ♦ .� .♦ ♦ t �j(� and avat(abfe options <br /> Please round to nearest dollar DO ¢_ <br /> ' 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes No ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes EINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes 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) es - <br /> 7. Is this to correct a violation? QYes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112 4/08 (Continue on Back) —► —► —I.( ) <br />