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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 7I me ,,/ <br /> 13 �f �' `� Ime f&-4a/l so"- ❑ Zoning St s;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip)Q / Deed striction;CSM <br /> 3 7 5 P N . POr/1� /\QQPL Va ' nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME /1 CO TRACTOR NAME <br /> /'�0 ie fib boa, d iK, diajd /e'om e/` ` Site Plan including location <br /> GE TADDRESS CONTRACTOR ADDRESS of well/septic <br /> /O Alen heed "'w f We/3 f3arrb y <br /> C' State,Zi <br /> ( ) , (City,State,Zi Setbacks <br /> Mad/so�c al:- .53 70V wadi so& GJz 53 70Y <br /> PHONE PHON/c <br /> X:ite Plan approval from <br /> o 0I y5.3 756 7 CP OS' J /7 0777 pplicable township: 1`1 <br /> E- LApDADRESS / E-MAIL ADDRESS <br /> a#A n ,hckovid4;/IGimai/- CCim) Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: �! A P P rty <br /> ❑ NUMBER 03 VC)/(,�g*"'af V.-7,5 (7 -3 t 1 -, 3-10 ,39/ frontage drawn to scale. <br /> TOWNSHIP SECTION: <br /> ,ryt)��/�� b, a 1 1/4: .5E ,/a,/, v E ISI Driveway permits <br /> ADDRESS: (state,county,town)Afs- <br /> J 75R NUP/h P©/r77L 1 Sanitary permits <br /> CSM: LOT UBDIVISION BL �p�-OT IV <br /> O∎ S.� inh I (public,private) <br /> PROPOSED PROJECT INFORMATION ? <br /> PROJECT DESCRIPTION' r, e. i Q / l K {, �r- <br /> t...'--," ,. / %.. / 'r' "� <br /> . ❑This project is a new building or structure. �, .;; <br /> This project is an addition/alteration to an existing building or structure. V€ ' <br /> 1 r <br /> SANITARY SERVICE: PERMIT NUMBER: *; a°1 , , � , <br /> ❑SEWER XSEPTIC "° <br /> HEIGHT IN FEET: NUMBER ST,I1ES: (Not including basement) <br /> I jr 04 V./ � ` 7 ak <br /> AREA TO NEAREST SQUAB FOOT: Wit. - <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) _ <br /> BASEMENT: ^ O 1ST FLOOR: e.y� ® l$ �� <br /> C. "7 eaa._- ,l TOTAL SQUARE FOOTAGE: ,+ - g ',. . °' . A P <br /> 2ND FLOOR: 3RD FLOOR: / f,.,,' � � <br /> ESTIMATED CONSTRUCTION COST $ 2 ,.. 0 0 0 <br /> Please round to nearest dollar) "+ '7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes $No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? %es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L No• <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le ve blank if none) <br /> 6. Is a location survey required? (see reverse) Ng Yes limb ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ($'No <br /> 4i C. APPLICATION MUST BE SIGNED <br /> 545-112(4/08) ; ' i (Continue on Back) -4 —► <br />