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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> , <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME_ <br /> C. V rt <br /> 0i. Zoning Status;CUP; <br /> OWNER ADDRESS (Nu ber,Street City,State,Zip) Svy� Pr€ r/C W t Deed Restriction;CSM <br /> 30% CASTLETU>J 1 �SINf1 $3510 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 31 S—OD S '�� Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> MAiz1C. SR.6 woo DS-N-WIN-TE:rt du t.rgT. L'Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2119 SM i'orrs4- --Y •297`1 5+arcrc54- -l-ir 1 . <br /> (City,State 5 <br /> (city,state,zip) Setbacks <br /> 5v ✓1 i...vrit �535f0 _5v'>h rrai ',I'-r , W it S-3SS,,` <br /> PHONE PHONE eat Site Plan approval from"'' A <br /> b 0 t- ��Z{-4/6 3 b 0 $ 1-/q4-1-4/6,3 applicable township. /I <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> %Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elti <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: evaon of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> tfXDriveway permits /V/ <br /> iia1S'rp L +/: /+/; <br /> ADDRES (state,county, /WI� <br /> /7 Sanitary permits /N i <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIP/TIIION:M2-.A-c5- 'a` ' ` <br /> ❑This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. : 3-� �� `. <br /> SANITARY SERVICE: PERMIT NUMBER: ) ., �� <br /> ❑SEWER %SEPTIC 1 Ira'4a ' <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) � , �� <br /> j q <br /> AREA TO NEAREST SQUARE FOOT:` ` .44i, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - #E , <br /> BASEMENT: 1ST FLOOR <br /> 7 $, <br /> or U 4, TOTAL SQUARE FOOTAGE: 3 , ,,° a ° .,": <br /> 2ND FLOOR: 3RD FLOOR: . _ <br /> ESTIMATED CONSTRUCTION COST: 2 Q p 0 6 t , ' J� <br /> (Please dollar) -► ♦ -► -� $ !�U , �� r ,, "-,' s <br /> Please round to nearest dollar <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IR o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes !L o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? LI Yes e+ No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? , Yes ❑No 2,40VOV/f''SII <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 sNo ❑Don't know 40,23K9 <br /> 7. Is this to correct a violation? ❑Yes 'fJo (a)/( ) /, <br /> APPLICATION MUST BE SIGNED' C <br /> 545-112(4/09) <br /> (Continue on Back) -► -11. -► O t t S <br />