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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION U ER TO PROVIDE <br /> O W RN�Mj <br /> �- / vv d rPyt / /�// � <br /> Zoning Status;CUP;_____ <br /> NER ADDRESS <br /> (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 6E80 1t Re( Lea WS $3S-SS Varian (# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 668-S92- _: =0 »(He,I( . - . t.'kt.Ae* ' e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 11,546-17.1 including location <br /> AGENT ADD CONTRACTOR ADDRESS of we tic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑Si a pproval from <br /> a ca a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUR T ONING: AC GE: Ele Ion Of property <br /> ❑ ( l )0/ �T� ZA ntage drawn to <br /> scale. <br /> NUMBER , <br /> TO HIP: SECTION: <br /> Awl ? 0 IA: -5 j" ,RA: ❑Dri permits <br /> ADDRESS: (S , ounty,town) <br /> C e�6�0 LOT � P SUBDIVISION BLOCK/LOT <br /> Sanit-• - rmits <br /> (e.. Ic, •rivate) #0.._.. ., <br /> ir <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW ) <br /> PROJECT DESCRIPTION: '� pp 11 G•rr <br /> fS X R S JW � -�iov- oning District <br /> . ❑This project is a new building or structure. Pe Itted.Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBS ❑ Rural ddress <br /> r)EWER [EPTIC (ne XIS <br /> HEIGHT IN FEET: NUMBER OF STORIES including basement) <br /> 12. ❑ Wet dplain/ <br /> AREA TO NEAREST SQUARE FOOT: S reland ttachmen <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Era • CO of permit <br /> (y/' f/ ,, TOTAL SQUARE FOOTAGE: ,, (slopes, P. turbance, Also <br /> 2ND FLOOR: 3RD FLOOR: `r flllln• C• SS) <br /> 3C/4 eview Loc-ti n Survey <br /> ESTIMATED CONSTRUCTION COST: and available o lions. <br /> (Please round to nearest dollar) ♦ "♦ ♦ ♦ ♦ ♦ $ Jo �0, 60 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes alo ['Don't kno <br /> 2. Is there a wetland or floodplain on or near the property? [Yes IRINo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes Elo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes JNo <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 ■lo QDon't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -+ <br /> 545-112(4/08) <br />