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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App# <br /> w <br /> PROPERTY OWNER INFORMATION ,, : __ ' :' ' Z1 w0, .: : s. -,: t,-1 CUSTOMER TO PROVIDE <br /> OWN R NAM lltiiPS -Q A �e a e ISO <br /> n Zoning Status;CUP; <br /> OWNER ADDRE (N ber,Street,City,State,Zi ) Deed Restriction;CS <br /> M hOu S ecie `ac ' E cu,--141 to' I 5-3 <br /> S(s Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> I I 3 a 5 C 5-77-3q55 II Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION ' ;;;=, and includes dimensions <br /> AGENT NAME CONNTT CT R NAME Con , <br /> \ J-P I It { S---riiA Ch(Y L • Site Plan including location <br /> AGENT ADDRESS CONTRITOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) • Setbacks <br /> Ai LJi 5550 <br /> PHONE PHONE • Site Plan approval from <br /> 19— ' q rl C1 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> • Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION':;(http:1/accessdane.co dane.wi.usn 11 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: -1...1 ACREAGE: <br /> p P rtY <br /> LI NUMBER v SO 0 3 \of'$500 r t--- oZ frontage drawn to scale. <br /> TOWNSHIP:. (� �1 0.-I,� SECTION: Driveway I a u is I \ ' : 1/a'/4: y permits <br /> ,county, own <br /> — ,� (state c `1 town) <br /> ADDRESS: <br /> b 00.5 :eeve R"` • Sanitary permits <br /> CSM: LOT ) SUBDIVISION BLOCK/LOT (public,private) <br /> la3I8 <br /> PROPOSED PROJECT INFORMATION _ _ <br /> PROJECT DESCRIPTION: C�7�� o/� z-,,r„`, <br /> tg This project is a new building or structu . f <br /> • ❑This project is an addition/alteration to an existing building or r.,,,L <br /> SANITARY SERVICE: PERMIT NUMBER: °'.' 4 <br /> �m�s��� e arr-�� �` ��e <br /> ❑SEWER ❑SEPTIC 3_ � � <br /> ;CT IN FEET: NUMBER OF STORIES: (Not including basement) d s S <br /> AREA TO NEAREST SQUARE FOOT: ' x <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) i'` ° t4 �r <br /> B MENT: 1ST FLOOR:I <br /> 3 I 1 TOTAL SQUARE FOOTAGE: , a s ,i„ .° <br /> 2ND FLOOR: 3RD FLOOR: ♦ �8 � j cK <br /> 3II ( rf:-..:_,,--,z,,, _._-.:_:,-.- , -7,J.•-4 <br /> ESTIMATED CONSTRUCTION COST --► --► -4► -i � . ° ,l ® 4�tm t <br /> (Please round to nearest dollar)1 I � � � � <br /> 33k. <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. there a wetland or floodplain on or near the property? Yes ❑No 0 Don't know <br /> 3. ave you talked with the township about your project and are they in agreement? Yes LI No <br /> 4. as there been a zoning permit issued for this property in the past 5 years? )Yes ❑No <br /> 5. I- this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. I- a location survey required? (see reverse) ❑Yes ❑No 0 Don't know <br /> 7. I• this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -► -► <br /> 545-112(4/OB) <br />