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• 1 l- ,-,3( = 11--1-)( . 01S= I o .(� *S O = 0/iii <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY.OWNER t:INFORMATION 2i�; z=_ ; uA"-,3-i r; .i. s) ,',; CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /e0 8t'Q Tom' e#?B • l,J�,v D' j,'4'" i 4.°e-'`'? Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,eet,City,State,Zip) Deed Restriction;CSM <br /> -2 it ? o2D /9.! i'V ©Nc'ae-/ Gt)• 67.34-€4 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6q SS$ 7 Site Plan drawn to scale <br /> AGENT INFORMATION.;;: CONTRACTOR::INFORMATION` = ,;;; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME / <br /> i c Ale R Q A • /' 4 G r 0'4 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3 re S` 1.1.4 t `'CR,S arNj k <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> 57'd 4464/7-6".)/ i,- . ss'f <br /> PHONE PHONE A Site Plan a oval from <br /> Gpg - A'Ze_ 7/6 applica township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> j1'_qFloo,r,pans to scale <br /> PROPERTY/LOCATION'INFORMATION ::(http:1/accessdane.co.dane.wi.usn; Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ p t 3 frontage drawn to scale. <br /> NUMBER � /�Q«�.��Z�O�'f /T" I C'�C . O <br /> TOW SHIP: SECTION: <br /> /�Ara�4 5;4 e'• 'v t a/ 1/4: t4 t,J 1/41/.: \j E P ' Drivew rmits <br /> ADDRESS: State ) <br /> ( ty,town <br /> 7-06 ? S ky /.\•••q_ A a, <br /> ■ . ani ermits <br /> CSM: I LOT SUBDIVISION BLOCK/LOT "— (publl , rivate) <br /> PROPOSED PROJECT INFORMATION; '- _ F ,, T '7'3„,,;,,,f:14,- <br /> PROJECT DESCRIPTION: .,.: 7, <br /> LOA eP lc/.a:r G�Ccecsab/e S-�o/1 o� �h�A `- � '^ f���� v � <br /> • ❑This project is a new building or structure. tr <br /> -This project is an addition/alteration to an existing building or structure. v . <br /> SANITARY SERVICE: PERMIT N '::f01$_„�°s('F <br /> 0-6EWER ❑SEPTIC / ; L '72 <br /> HEIGHT IN FEET // NUMBER OF STOR -(Not including basement) .y- ' <br /> J . of e ::-A i 1, 3;� N� <br /> AREA TO NEAREST SQUARE FOOT: d- Yt <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) * ” �,flit BASEMENT: - 1ST FLOOR: e ®����� k '� � , <br /> 1 V ,, TOTAL SQUARE FOOTAGE: j, e �� Cx,1-5l <br /> 2ND FLOOR: 3RD FLOOR: s <br /> s i'1 <br /> e us I'-1'' sArk,ck <br /> `,y �'ESTIMATED CONSTRUCTION COST: 9« <br /> (Please round to nearest dollar) --o• -÷ -+ 0 "♦ '♦ $ o a O. 0 p : { <br /> " <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ®-Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No aDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QIYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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 2.No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes CN Io <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —0 —► <br /> 545-112(4/08) <br />