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r ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME MO ( <br /> ,v,Z 1 DO 'T <br /> MO a-Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,zip) Deed Restriction;CSM <br /> 34U t 7 I�S7AD c.>� ljE4 , FI ELbw) 53531 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 409-70-Sy so 66E5 Z3S-33 ill'a 2-01-1 RILL, IA4 ORE C#41)0154,J bite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ` <br /> 14 NJ 1,5 CUB 57 R )c-t/v N a-Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRLSS_ of well/septic 14,- <br /> 6 E I s, ID .9- N N 5 /T �p <br /> (City,State,Zip) (City,State,Zip) I� -Setbacks <br /> wVItre WAALix l 530 a <br /> PHONE PHONE Site Plan approval from <br /> z4,L- to 3- 551D applicable township. 44' <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ca-Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn dElevation of property <br /> PARENT PARCEL NUMBER: CURRENT O ING: ACREAGE: P perty <br /> Kt U o !f 071Z�30 —ef170 o 5 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> '�. a g.F I c Q 1/4. 1/41/4: a Driveway permits N4. <br /> ADDRESS: (state,county,town) <br /> 308 T 4o $TAD Lti e FI g c L i S35 31 I Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) 14 <br /> PROPOSED PROJECT INFORMATION , <br /> PROJECT DESCRIPTION: !1 r/�0 P ;� <br /> ®This project is a new building or structure. 4 <br /> ❑This project is an ads Lion/alteration to an existing building or structure. , _,T' i � <br /> SANITARY SERVICE: • PERMIT NUMBER: e a <br /> ❑SEWER ❑SEPTIC � �gri v3;ii s� <br /> a <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 0 N ' era 9,,i!I l 1'.i- i 11 _ <br /> 98 9 p,- ,_' <br /> AREA TO NEAREST SQUARE FOOT: `'F '- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: x� <br /> NA QVV <br /> 4, TOTAL SQUARE FOOTAGE: t � w s s 2r.rr <br /> 1)® <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: <br /> Please round to nearest dollar 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ki No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ig No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ilIYes ❑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 611No ❑Don't know <br /> 7. Is this to correct a violation? BYes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► - <br /> 545.112(4/00) <br />