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h <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW‘Nr NAME /� <br /> 10— Cell kt-io r S ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Stag,4ip) Deed Restriction;CSM <br /> •q 1 S 61 Z__e -e ('C - Z.odi I w( .-3 Sr — Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRE <br /> Coo j.- t9• -/S 1-I ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /het6� . c : CI Site Plan including location <br /> AGENT ADDRESS CONTRAC ORADDRES <br /> 5 �� of well/septic <br /> (City,state,Zip) I L . (City,State,Zip) aiq &?144.r w,, ❑ Setbacks <br /> (.2/1 5.35 7)'^ <br /> PHONE PHOJsiE ❑ Site Plan approval from <br /> Q4 ' — —110'1 -- g-7 a C7 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS j <br /> K•CV,'� '/y(C.,S bk.ti h • Co/'►-\ ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: operty <br /> ❑ NUM ER C qD 6°J/g 3066 frontage drawn to scale. <br /> TOWNSHIP: . <br /> Lq ,-L _ ,A: 1/41/4: ❑ Driveway permits <br /> ADDRESS: / (state,county,town) <br /> 1 8'- �t ed ' Lod t' T3 3 5'� ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION t o <br /> PROJECT DESCRIPTI f F =€` .- <br /> • @mss project is a new building or structure. ;- - `- <br /> ❑This project is an addition/alteration to an existing building or structure. } W <br /> i4 ,' ,.. <br /> SANITARY SERVICE: PERMIT NUMBER: °"° e, a :..i.'. - e� � <br /> 7a. 4 <br /> ❑SEWER CI SEPTIC � - + �� x: '--- � <br /> � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) g � <br /> �* cj _ f .AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4 - <br /> BASEMENT: 1 ST FLOOR: � o ® a a <br /> )63-0 j TOTAL SQUARE FOOTAGE: j r i ;� r <br /> r <br /> 2ND FLOOR: 3RD FLOOR: / \ ^ <br /> 1 6�J � , ..�. E ,:', -tip <br /> ESTIMATED CONSTRUCTION COST: i f T <br /> (Please round to nearest dollar) $ 6Q 0 0 Q , ,• - <br /> `/ 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes aQo ❑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 0110 <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 Cho t know <br /> 7. Is this to correct a violation? ❑Yes 8 <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -4. —► —I. <br />