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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAME <br /> rib s O v© Y 1 C2 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,StathZip) Deed Restriction;CSM <br /> /et be ('i--k V n <21k -4 ot'soi k (-U(‘. 5)76`) Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AD gSS <br /> 60V• as-7. 11360 &'°4 '6 5 A - ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /1'i C f ,s t P ❑ Site Plan including location <br /> AGENT ADDRESS CON�TRACTeR ADDRESS of well/septic <br /> /Sd7 Ski Si, . <br /> (City,State,Zip) 1 (City,State,Zip) LI Setbacks <br /> a'`41-/' BIRD z4Y,(-4 u(. cS�-15� <br /> PHONE PHONE ❑ Site Plan approval from <br /> 0 ' 9-- a7,21- applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /4.4/, t Z Ih.�t , s .bit(Os, .1-. ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER O�fa-OTC y-33Y-$tX{G 3 A- t�yC .3 s <br /> TOWNSHIP: SECTION: <br /> O re.a1j p y\ ' '� '/4: WA: ❑ Driveway permits <br /> J (state,county,town) <br /> ADORE <br /> 35 t `i xi//i rl,c <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> cuP Z.0€3,1 <br /> PROPOSED PROJECT INFORMATION ,", _ 3 <br /> PROJECT DESCRIPTION: <br /> 5 9.8 $ ;. .y <br /> . This project is a new building or structure. , g <br /> ❑This project is an addition/alteration to an existing building or structure. . ,. <br /> SANITARY SERVICE: PERMIT NUMBER: a� <br /> ❑SEWER ASEP:T--C 1 "k Ai a, <br /> r �' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 3- �` "; <br /> i -ate 4aei 1 .k' <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: - . r, <br /> • CiL iZcc'I-�'i s 5.987 ,}, j TOTAL SQUARE FOOTAGE: + &" i ;" i q -, <br /> 2ND FLOOR: 3RD FLOOR: ` ' <br /> as § <br /> ESTIMATED CONSTRUCTION COST: <br /> ♦ ♦ ♦ ♦ —► —► m `sera �� <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? 1Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes L#i5, ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes J-f'd'G <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 ❑No , Don't know <br /> 7. Is this to correct a violation? ❑Yes 1.3l4 • <br /> i4cK m4 -71 I - S8 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -I. <br /> 545-112(4/08) <br />