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z.r43 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> SCDTT f S Mu MA saI4U LLO Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> t835 I,(+,(Nak qc o UN,TIf10f MaDI5°4,VII 631 04 Variance(# ) <br /> HOME PHONE CELL PHrn4E E-MAIL ADDRESS <br /> -1206-`(b7-7 ' 107'590-5/ - ,St1 otse.ita10.ca., It Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Pand (/V14r4'eA TGp au 1 Lai ers IA4 Er Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> z Pf 1 ‘644,,L14 V p,1 kE 2051 CouM TPA( IDW ve' - <br /> (City,State Zip) (City,State,Zip) [etbacks <br /> S l.vl t rairla , iw}. 5 3 5 90 svh Prairie , t4/ . 5 3 59 0 <br /> PHON PHONE I Plan approval from <br /> cL (`L Os—Z 1 Z -129 34 (-bog - '337- 19 3 Z applicable township: <br /> E-MAIL ADDRESS , ADDRESS <br /> Nod yblar f en 4, wll d blue ,he' r .4 Ow(days ii, uerl zah .Her Vor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ltif <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> ❑ PARCEL 2— 0 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> W11oot TUB• '/a: 1/41/4; Driveway permits <br /> ADDRESS: (Z130 eO 1 /ate,county,town) <br /> nita permits <br /> CSM: LOT SUBDIVISION BLOCK/L•T <br /> Sanitary p <br /> i z t 2 $ 3 ►•IA N A (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> ` ' <br /> PROJECT DESCRIPTION: <br /> ' . <br /> $ ,3 ;�GW cV' 7 b c:rrom f✓t a a„ / ;:,:i„;., <br /> ' � a : <br /> ErThis project is a new building or structure. <br /> ID This project is an addition/alteration to an existing building or structure. _ <br /> SANITARY SERVICE: Na ; ) e a `, <br /> ❑SEWER ErSEPTIC <br /> 6.HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) K <br /> Z�'1.,b 1 � tl ,i, P 1€ ,-t, <br /> AREA TO NEAREST SQUARE FOOT: �'�� . r��^i <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)BASEMENT: 1ST FLOOR: 5 ® s a P <br /> 2.0+I— `.0 4_2 4 I of 3 , TOTAL SQUARE FOOTAGE: , ° d ?,Y <br /> s <br /> 2ND FLOOR: 3RD FLOOR; <br /> N A A S/Z 7 ` � <br /> ESTIMATED CONSTRUCTION COST: QQ�� - . 0 � g, _°a, <br /> (Please round to nearest dollar) '� "� "� •p 0 <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 ffNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? RaYes ❑No <br /> -- 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 5{'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />