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. ,Ta ei t7) s <br /> mai 1 0 { emou e-) Cf7- _ j7 Ian <br /> _9 5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNAME CUSTOMER TO PROVIDE <br /> �.e ,,, 4, �(L.AS C3 Ct;4 Ma— ►'! ;ning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) . , <br /> —�!g!eI. D e. ©A •D�' M�yy11 r 5 -- Q Deed Restriction; CSM <br /> HOME PH NE CELL PHONE E-MAIL DDRESS J Varianc- (# ) <br /> - 12th .� . <br /> • and includes drawn to sion <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> a GE �'#EPfan including location <br /> AGE TADDRESS CONTRACTOR ADDRESS Of ell/septic <br /> i20 E . LAlsow. s-- <br /> (C y,State,Zip) <br /> (City,State,Zip) A S�1 Setbacks <br /> MAC (SON.- S 37 03 <br /> PHONE PHONE tfI Fite Plan approval from <br /> b ( I L( Z— 1�10 pplicable township. <br /> E-M LADDRESS G E-MAIL ADDRESS <br /> o �' >•3 • la S' or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURB T ZON NG: ACRE <br /> Elevation of property <br /> LI PARCEL <br /> NUMBER 2k6(t•35 j•g08'(�..1 `—�- Q fr ntage drawn to scale. <br /> TOWNSHIP: SECTION <br /> D�- N', Ai e '/4: /VL' '/4%. Driveway permits <br /> ADDRESS: ate,county,town) <br /> /"(A t.VM S co. R6. (4dj S 7 0 ' ) Sanitary permits <br /> CSM: LOT SUBDION BLOC K/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION a . <br /> PROJECT DESCRIPTION: <br /> ew .51145r� y 12-e ll e 97. 7 .. <br /> I �• " <br /> • his project is a new building or structure. i.1 5 <br /> ,1414-Ulaka47.44ii',;14f' <br /> ❑This project is an addition/alteration to an existing building or structure. tliiitNiTAKAii,,ALV0,44,r1 <br /> SANITARY SERVICE: <br /> PERMIT NUMBER: : i. f, ':_ <br /> ❑SEWER SEPTIC I °� 1 d-- <br /> HE HT IN FEET: NUMBER OF STORIES: (Not including basement).20(5 / I fix^ ��; <br /> REATO NEAREST SQUARE FOOT: • ' ft:',;,,,,, -,:,vir.(Outside dimensions inclu.' fished area,attached gar above grade decks or porches) <br /> BASEMENT: i ST FLOOR: �'`r "s r t 4 <br /> 7� ��� / l ` TOTAL SQUARE FOOTAGE: + g:. s• -' <br /> 2ND FLOOR: W 3RD F OOR: ' <br /> ESTIMATED CONSTRUCTION O` <br /> TRUCTION COST: 465 0 0� <br /> (Please round to nearest dollar) "■ '■ '+ '+ "► —► $ "I" <br /> ,...,,, ,,,..„...„„.,... ...,......„ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes ANo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 14m ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? fes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No T <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) LI Yes grNo LI Don't know <br /> 7. Is this to correct a violation? Li Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112 taioet (Continue on Back) —0,- —► -4. <br />