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• <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Onu 1t-t\ ) ,e_- .\1..-E---)2_. a Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 2 � LL-tAYI/v 1)iZ1VE. ST0i.(.C;,*1f�l-01.4 •' Vaiatcee(t#riction;CSM ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> a73 Le 57I,-350a b(S • _ - 44 V0,Cowl a Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I. E1.143 )?6,vSi NCr)O%) 19 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> S 4-Y'1 -- . <br /> (City,State,Zip) (City,State,Zip) la Setbacks <br /> SP4-7v4 <br /> PHONE PHONE a Site Plan approval from <br /> j cO 23.-&ory applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SA,.yn,c , Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) 0 Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> 53 PARCEL fir--3S R H_ 1 )' (9 frontage drawn to scale. <br /> NUMBER 1� <br /> TOWNSHIP: SECTION: Driveway`P2.-- 'T s-lZi o c.,5 IA: '/.'/4: Y Permits <br /> ADDRESS: (state,county,town) <br /> .3-23 yA t 1I474I S de l V'E Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 3,S3 (public,private) <br /> 6 <br /> PROPOSED PROJECT INFORMATION <br /> ;PROJECT DESCRIPTION: , k <br /> KES AccZSSa a IA t ' <br /> e ,, <br /> . a-This project is a new building or structure. -1 . , :. 4 <br /> ❑This project is an addition/alteration to an existing building or structure. - ' � <br /> SANITARY SERVICE: - ell o ,% <br /> PERMIT NUMBER: a <br /> ❑SEWER ❑SEPTIC � �°�.: � <br /> H IGHT IN FEET: $ NUMBER OF STORIES: (Not including basement) `" � <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � , 4' <br /> t g <br /> BASEMENT 1ST FLOOR: r 1 a , <br /> AZ (10 4, TOTAL SQUARE FOOTAGE: 4 5 4,r, <br /> (j rs to ti ``r ".:'''''4::-.--"3-=,::-.7:: <br /> 2ND FLOOR: 3RD FLOOR: -; , <br /> ESTIMATED CONSTRUCTION COST: <br /> Q� <br /> (Please round to nearest dollar) ♦ -∎ ♦ "♦ ♦ ♦ $ ,..-.:::j( .-...;44,-.`...-'-,-4 $� g p 1 <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? 0Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes la No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes gNo <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) CI Yes gNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes s-No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />