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S3 - 50 <br /> ZONING PERMIT APPLICATION w countyyofdane.com SUPPLEMENT to Web-App # <br /> ww <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> C ci r yr l ovTh c o S LI Zoning Status;CUP; <br /> OWNER ADORE (Number,Street,Cdy, W State,Zip) ` Deed Restriction;CSM <br /> cD r g L h d R t t;1 ON(``F C Cy(1 63S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS V <br /> ( c -1)3 5 •• S 3 0 - ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includesdimensions <br /> 1T NAME CONTRACTOR NAME <br /> LQ— .Q��, ❑ Site Plan including location <br /> ADDRESS CONTRACTOR ADDRESS of well/septic <br /> NG;,Ry y (Cib,State,zip) ❑ Setbacks <br /> PHONE / PHONE ❑ Site <br /> it Plan pprfrom <br /> Caog- .8L. - 1 ) , _ applicable township, <br /> E-MAIL - � 1 -tt t)O E MAILADDRESS ❑ Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http: accessdane.co.dane.wi.us ) ❑ Elevation of <br /> P ENNT PARCEL NUMBR:E CURRENTZONING ACREAGE property <br /> ❑ PARCEL D . ■ __ 0 _g 18D •• # t frontage drawn to scale. <br /> . -. • .ti <br /> Ta, ((��� C N R 1 E , ❑ Driveway permits <br /> DU h —� �+ .� 4. /•: (state,county,town) <br /> 01 <br /> ADDRESS: <br /> `o i1\ I on \) 8 ❑ Sanitary permits <br /> cste • + ,`�i <br /> LOT ��3� t ION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> Pf‘OJECTOESCRIPTION: ga 13'4.\h OG Im <br /> ��cc> t�l 2>c' iS �u,v � � •m• _ - . ' 1 - eO`. '' <br /> Li This project is a new building or stru re. <br /> hccSrn to-4•&-e Y∎ <br /> Phis project is an addition/alteration to an existing building or structure. <br /> Tz <br /> SANITARY SERVICE ` ,R , <br /> ©SEWER PTIC <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Nat including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> _ CC <br /> BASEM J 1STS <br /> 5))17—S <br /> TOTAL SQUARE FOOTAGE: j <br /> 2NO FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ COO <br /> (Please round to nearest dollar) $ (�� <br /> 1. The pro perty is within 300 feet of a stream or 1000 feet from a pond or lake? UYes WO ❑Don't know <br /> 2. Is there a wetland or fioodplain on or near the property? _iNICIYes liglo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es la No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Laves OW <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan - none) <br /> 6. Is a location survey required? (see reverse) El Yes '� • ❑Don't know• <br /> 7. Is this to correct a violation? Lives N� <br /> APPLICATION MUST BE SIGNED <br /> / 3,1 (Continua on Back) -► -►515-112( C) <br /> Y_____.1..............° <br />