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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME a <br /> inn <br /> 'l Am k)I' -rui ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> I(3 3G, 5. d ot.co/1/4rt.J P P. '�''-c� ''- 14 D Variance(# ) <br /> HOME HONE CELL PHONE E-MAIL ADDRESS <br /> 332-31 Y2- LI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> • LI Site Plan including location <br /> AGENTADDR S CONTRACTOR A ESS of well/septic <br /> 11.0 4 W►(50 1t s`F • /�/�( v� <br /> (City,State,Zip) (City,State, . ) )G ❑ Setbacks <br /> OtA-{J L.5 a u 6-37 0 3 <br /> PHONE PHONE - ❑ Site Plan approval from <br /> y(1z ---C b Z D applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -1 ' _'L'1, b's-- - /c ar 7:44.4104 Xi„,..e.a, ear ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: LI Elevation of property <br /> ❑ NUMBER 2 t oG/e'oa Y 5)9` , frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> '/4: '/4'/a: ❑ Driveway permits <br /> K (state,county,town) <br /> ADD / <br /> ht33 G S• Yoiz A-u i R. -t,���' -€L ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW N <br /> PROJECT DESCRIPTION: ll *'. <br /> -e ie✓ -S/iii y/4- /4 la#Y7 ❑ Zoning Oise <br /> This project is a new building or structure. LI Permitted <br /> This project is an addition/alteration to an existing building or structure. "� ,,,; <br /> LI 4*Address <br /> SANITARY S RVIC • PERMIT NUMBER: �+ � : <br /> SEWER ❑SEPTICtesrN/# �ti} 1 <br /> HEIGHT IN F NUMBER OF STORIES: (Not including basement) <br /> etlaniigloodplain! ,' <br /> =I� bra(and (attachmet' )' : <br /> AREA TO NEAREST SQUARE FOOT: "ti. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionCcsr trot permit <br /> BASEMENT: 1ST FL0 %. <br /> /C7}� /co 4, TOTAL SQUARE FOOTAGE: j 4 34 to r disturbance, ra <br /> / " bras) 5 <br /> 2ND FLOOR: ERD7CCOR: prr c,(,., 4-!FIll1� <br /> / 2 q 6 /7a }►70 .4-1vo <br /> I 7 �� ❑ Review(i," Iibn 001ctitey. i <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦4(JQ♦ $ 0 nda+vaila yle{p o sy <br /> (Please round to nearest dollar) •A 3��0 0Q• /f i' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0<s ❑No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es LI No f 'bon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No 7 <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# ) (lea lank if none) 1 <br /> 6. Is a location survey required? (see reverse) es ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -, ♦ -► <br /> 545-112(4/08) <br /> 5 Li___,".4..," --,2,,,f,o,.- c.x., ./ At-x-7') <br /> SE ZOoJ'DZZ t <br />