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. �S__ Li -tc e G\''Q V7/)-- /t 1-/-c--k ) —7 1 ¢J <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 11 <br /> i-u I a )4 ± Yo n c-f /'( Ke F-1 _ )Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) S 3 SYoO Deed Restriction;CSM <br /> 9a c/y s,p r J n J4 (( V �� fQZ an1Qhl 6 1,(1/ Variance(# ) <br /> HOME PHONE CELL PHONE EKMAIL ADDRESS <br /> 7,1 30/ 6 = Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C/ 4 r/ oat Id /nci !.p rio k Site Plan• cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well eptic <br /> Po t5 6' <br /> (City,State,Zip) (City,State,Zip) P. Setbacks f>' Ve.ron r� w l 535-- .3 <br /> PHONE PHONE Rt Site Dati approval from <br /> Qck <br /> 4 /ç *7130 ap cable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS / <br /> C I e Q r �a,, I c� I h .L l m �r i b <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �� Elevation <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACRE E: property <br /> 5-c <br /> ❑ NUM ER 018 - 174 -°I 00 d-� J-4 - ) • 1)=6 frontage drawn to scale. <br /> TOWNS SECTION: h <br /> �('_ f 1-7 '/a: 1 v 1,.y %%: S vv 14 Driveway rmits <br /> ADDRESS: (state, linty,town) <br /> l-\_ P. Sanita• permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1 o S3 ' -.,_/ (pu• c,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ! k <br /> . l 'This project is a new building or structure. , - - <br /> ❑This project is an addition/alteration to an existing building or structure. E" -- ' ��� <br /> SANITARY SERVICE: PERMIT N B R: a r` • = ' <br /> ❑SEWER SEPTIC /� � - � i �a a 3 <br /> HEIGHT IN FE • 1 NUMBER OF STORIES: (Not including basement) <br /> °l 1 � T.... i.i., 3 5 <br /> AREA TO NEAREST SQUARE FOOT: � a � ,,M•(Outside dimensions including unfinished area,attached garages and above grade decks or porches) . . x � ,, ,,r <br /> R <br /> BASEMENT 1ST FLOOR: � . .. •.. , <br /> x 3 4, TOTAL SQUARE FOOTAGE: y r �`Z u*. <br /> 2ND FLOOR: � 3RD FLOOR: X ` � _ ' °- <br /> sS- sds <br /> ESTIMATED CONSTRUCTION COST: • ; ••i . <br /> ♦ ♦ ♦ ♦ ♦ ♦ �" //'� s <br /> (Please round to nearest dollar) �)J S(J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes -. Jo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes -6Lislo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes TNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes o <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 ,E,No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes -. 'Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4. -o. -► <br /> 545-112(4/08) <br />