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it ,s <br /> • ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N <br /> flit <br /> IP44 fi— 4* i ,4 i /4LK r <br /> OWNER ADDRESS (Nu be,Street,City,State Zip) ��" �❑ Zoning Status;CUP; <br /> 3;7 Zfr/ , c:- t, 4 J ," r� Deed Restriction; CSM <br /> L''������� C Variance(# ) <br /> H HOI CELL PHONE E-MAIL ADDRESS &r <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE NAME ,' CONTRACTOR NAME / <br /> qfri <br /> w / t% D{ V(J044t - / q' .1-bJeci Piduh Site Plan including location <br /> AGENT RRESS CONTRACTOR ADDR SS of well/septic inKrpio 61-40/40(City,State,Zip) (City,State, 'p) / ❑ Setbacks <br /> IN CPM1 1,9 ) .�3s3 di' Ua►J d-J ire', &if S.12 / <br /> PHONE f� g PH NE ` ❑ Site Plan approval from <br /> kd G' �S� j2V - '7i I Ii 2.- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Li Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.usl) <br /> PARENT PARCEL NUMBER: CURRENT Z NING;� ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL Osi2 �y2/J—, '9 R L,, frontage drawn to scale. <br /> NUMBER J b S /'� <br /> TOWNSHIP: SECTION: �` of <br /> } L(� Ai /;) /. 1/,-//' `o ❑ Driveway permits <br /> AD RESS (state,county,town) <br /> 44-/(�'17 1-= 0/. ,.� 1,0(- K <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION�" ,f- LOCK/LOT <br /> /r d,,,,6;?-7.2..... ,/' /4 6 Oft' (public,private) <br /> PROPOSED PROJECT INFORMATION " STAFF 4;tEVIIEVIT. <br /> PROJECT DE I TION <br /> Ii£ / 1' ( „r_ . i t L o Zing Di tract ',4 <br /> ❑This project is a new building or structure. = i <br /> �rf�ti(ter�•U�e� <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: iLi Rural;Address <br /> SEWER ❑SEPTIC L (new/existi,'ig�) 0: 4 <br /> HEIGHT IN EET: NUMBER OF STORIES: (Not including basement) _ N a `"' <br /> J?'b' Wettalnd/Floodpla n/ <br /> AREA TO NEAREST SQUARE FOOT: cShoreland a 014010 e� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: p / 1ST FLOOR: ❑ 06i6ilCOrifrol idiiiit <br /> Cte -L // rP� j 4, (sl <br /> TOTAL SQUARE FOOTAGE: opes,disturbance, t <br /> 2ND FLOOR: 3RD FLOOR: <br /> V IllIng/acce,Ss) <br /> /1",6)' iooti Lie <br /> U r f vio Ltio ion tuNey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -► ♦ �� r 22 andav able option „ f <br /> (Please round to nearest dollar) L <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? , 'es ❑No Li Don't know <br /> 2. Is there a wetland or floodplain on or near the property? !, Yes Li No Li Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 'Yes O No <br /> 4. Has there been a zoning permit issued for this pro g:DEWED? Li Yes Jklo <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 ❑No Don't know <br /> 7. Is this to correct a violation? OCT 3 2008 Li Yes *Jo <br /> DANE COUNTY PUNNING&DEVELOP!NT APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -■ <br />