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`ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATIONS `� (/� CUSTOMER TO PROVIDE <br /> OWNER NAAe� .4 14 Q4 so v IQ� _ /. <br /> IF��J`, Zothling Status;CUP; <br /> OWNER ADDRESS (Num\br,St 1�C�ty,State,Fip) �, Deed Restriction;CSM <br /> 4'�'3 1- -P4`F 's --. soc (..3,',53-3 1 ! Variance(# ) <br /> HOME PHONE CELL PHONE l I E-MAIL ADDRESS <br /> 22L—t33c� "7 11-2854 I/ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NA (�, CONTRACTOR NAME <br /> Ovvt t.4 S ` 314- \ effrSite Plan including location <br /> AGENT AD RESS22 �^ I CONTRACTOR ADDRESS of well/septic <br /> J� 5 L C Si <br /> T. - l i�Lt6C,tLS6cDEIZ. <br /> (City,State,Zi ) (City,State,Zip) .CJ Setbacks <br /> � V4�dts�� �'t iii <br /> PHONE PHONE 111 - - ' an ..' : . rom <br /> -11)--15/SL( a.: • able s' - ii.. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Ievation of property <br /> PARCEL OZW606/D`402- ►_/ 2-Z + 5 L frontage drawn to scale. <br /> NUMBER / <br /> TOWNSHIP: -1 SECTIOGN: SS � \J ❑ D •- a . •5 <br /> town)4 t4 3 3 1J e-Ate J V 4�S O� O z . SS3` I I ❑ s It <br /> C M: LOT SUBDIVISION BLOC 0 OT <br /> 1 ASS sCc1`S Pt-4 r-A 1 4 <br /> PROPOSED PROJECT INFORMATION 1t �s <br /> PROJECT DESCR PTION: p 1� p y,N . �' =, <br /> -L. ) O.4 b�.S C- '5 '" 6 <br /> . ,This project is a new building or structure. .-,. <br /> ❑This project is an addition/alteration to an existing building or structure. *} <br /> SANITARY SERVICE: :- k®O_= `z <br /> � SEWER ❑SEPTIC ' �� <br /> 2 <br /> HEIGHT IN FEET: _ NUMBER OF STORIES. (Not including basement) <br /> iQ} Q�3v %F Ufk/is44 r , �q^,Y9 9. '".- ' ' c� a' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) -v. 4 L<x' , ,, .pt0. <br /> $ • s, <br /> BASEMENT: 1ST FLOOR: ,� �� - �Irwr <br /> l 0(06 S f 4, TOTAL SQUARE FOOTAGE: 4, , <br /> 2ND FLOOR: 3RD FLOOR: <br /> l C(OSC ?r• rr 1� s <br /> ESTIMATED CONSTRUCTION COST: o, <br /> Please round to nearest dollar l � <br /> C. SE .^- oZeli ''__.F <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? AYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? JYes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? AYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI 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 W Don't know <br /> 7. Is this to correct a violation? ❑Yes ,$1 No <br /> s 13 o APPLICATION MUST BE SIGNED <br /> 545-112(4/08) T 1 (Continue on Back) -0. -► -p <br />