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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•MMApp# <br /> — <br /> PROPERTY OWNER INFORMATION 0 Q V o ' <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> S�- ti-ton Ave"- VttiZ i' Memo t,C 1 R 1-k `� <br /> OWNER A RESS(Number Street,City,State,Zip) �r� � Zoning Status; P; Z. /pitie.�6 3 CELL H NE ot4 k COr7, all. S��i Deed Re( cti. ' M ) CE—f <br /> HOME PHONE E- ADDRESS Variance <br /> o9f�8'f•da39 16o�5o,-Y7i/ bred, htivr,CIhgne- Gyy,hoe.Crm d (�® � <br /> AGENT INFORMATION cgs. Plan drawn to scale <br /> CONTRACTOR INFORMATION and includes dimensions y/- <br /> AGENT NAME CONTRACTOR NAME r` <br /> gsite - ' g location '� f <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> Of " � <br /> -(City,State.Zip) L1 2 i/�q�.�c/ <br /> (City,State,Zip) Setbacks 7 i./! C/ ` 1' J <br /> PHONE PHONE Site Plan approval from <br /> applicable township- AS <br /> I--E-MAIL ADDRESS <br /> ` <br /> ■. Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) / <br /> EgiPARENT PARCELNUMBEt2� CURREeTZQNING: ACREAGE: Elevation of property <br /> PARCEL Der 4v-'' `�(\/ I Q.'3 g A. frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: <br /> SECTION: <br /> Plea saw/.S P rtn%4 31 1/a, k) , , S w Driveway perm <br /> /a/a: <br /> ADDRESS: W 9 C 3 0 g I C state,county, own <br /> / <br /> CSM: ! LOT Sanitary p .••: <br /> SUBDIVISION BLOCK/LOT <br /> 9 <br /> ` (public, ,dr- <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: / 1 STAFF REVIE <br /> �4•e- intIrov;,,t Park / 2 , 5- X `f, > 9( Li 1 S Zoning District <br /> • RThis project is a new building or structure. 0 1,, p v 'C ---- ,,°i' t Q��to <br /> Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. S r `) K � A.) <br /> SANITARY SERVICE: He e N e PERMIT NUMBER: XRural Address <br /> EWER MEPT1C uAlidn�-- /V/ A' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) °����� / <br /> . - -•-' ...plain/ NA <br /> AREA TO NEAREST SQUARE FOOT: Orel-n• ttachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,,,, ^ <br /> BASEMENT 1ST FLOOR: 0- rosionControl permit <br /> Sj TOTAL SQUARE FOOTAGE: j (slopes,disturbance, 'O i <br /> 2ND FLOOR: 3RD FLOOR: filling/access) /1 (V <br /> ESTIMATED CONSTRUCTION COST: <br /> Revrew Location Survey/��/ <br /> (Please round to nearest dollar) ♦ '� ♦ -i and available options. /� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ow QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes V o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? EYes U: o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ,JVo <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) 'e- q•1'1g4t-.6 S�.•rV-y...m <br /> /' cip 131fes Ow []Don't know <br /> 7. Is this to correct a violation? :Yes ato <br /> 2 — 7 3 G D - APPLICATION MUST BE SIGNED <br /> 545-1,2( ) ( // (Continue on Back) -i --t. -► <br />