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_ 1 . <br /> 94/ <br /> .' ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ',0" +Jwly /„,�I <br /> e 4444," <br /> Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Sate,Zip) <br /> �'8 /1 Dr,, Deed Restriction;CSM <br /> �►�J h ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 8 q S32-40 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG/E/ NAME / CONTRACTOR NAME <br /> /x/01 deg Cade G.e Dr r S Site Plan including location <br /> AGENT ADDRESS p CONY:, ::ADDRESS f well/septic <br /> $74 Lk,1w-J 1)r Se., //air,Q w) . <br /> (City.State,Zip) /'�p,� (City,State,Zip) 4Setbacks <br /> PHONE •�7.7�(/ PHONE Site Plan approval from <br /> WI-3'77.3 \applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .e.nf l+- 'age; �1 lour plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn `� Elevation of property <br /> PARENT PARCEL NUMBER: CURB TZONING: ACREAGE: ..k Elevation P rty <br /> ❑ PARCEL /O - Sc�-•b 79^S �^ ,/, ,L g, -frontage drawn to scale. <br /> NUMBER Q <br /> TOWNSHIP: SECTION: <br /> !t✓,�..dso-r' '),ci IA: 0 1/1/: SE Driveway permits <br /> ADDRESS: �/�] (state,county,town) <br /> 491 DD h De' it)/I 'so,r 114 S3 S,i? <br /> PI Sanitary permits <br /> CSM: LOT SUBDIVISION CK/LOT <br /> —� /0 SvIse ! p—'-' (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DE CRIPT N: / - .. � ' <br /> _ ELI x �-I ": � �',� <br /> . L his project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. °' <br /> SANITARY SERVICE: ��I�M fR '' $° 1-"s- g-: <br /> PERMIT �xB € .��� � <br /> ❑SEWER • PTIC ; i vs �i T � <br /> HEIGHT IN FEET: r p NUMBER OF STORIES: (Not including basement) <br /> ,41: 4 E tip a iti.- x w <br /> AREA TO NEAREST SQUARE FOOT: <br /> i4 _ E <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)_,i � 9 � : � 1 R �P <br /> BASEMENT: 1ST FLOOR: <br /> J✓1* 570 4. TOTAL SQUARE FOOTAGE: j V. .' "�.. <br /> 2ND FLOOR: 3RD FLOOR = 9 � <br /> ESTIMATED CONSTRUCTION COST: $ <br /> (Please round to nearest dollar) -+ "♦ ■ ♦ ■ -.. $ �2 nit, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes G .No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? FA,Yes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Q No <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) DYes LI No Aki Don't know <br /> 7. Is this to correct a violation? CI Yes KNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► ♦ -► <br />