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ZONING PERMIT APPLICATION wcountyofdane.com SUPPLEMENT to Web-App# <br /> ww. <br /> PROPERTY OWNER INFORMATION -- CUSTOMER TO PROVIDE <br /> OWNER NAME \ <br /> (jAr...y STMT Z 1^k Sri R1-I N 1Lk- <br /> OWNERADDRESS (Number,Street,City,State,Zip) ❑ Zoning Status;CUP; <br /> "O� W OOO'i ama Ln€ T �\` ' We a ��1 Deed Restriction;CSM <br /> k�.e- , Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ..' -�� ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME r� CONTRACTOR NAT <br /> l'S taso,v,ssF 1 ' ME3T ,,1IEST c_._ LI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> To. f! t 45410 .U. box 1-1.51-1 10 . <br /> City,State,Zip) (city,State,Zip) ❑ Setbacks <br /> MAC:1►5sn , W1 , 5374'( Maao■so-n , LJ , 5314 { <br /> PHONE PHONE ❑ Site Plan approval from <br /> (opt `71 to t L115(-1 CID Og' 33 —x811 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 1 av- • _y try ��ES . C1 '1' ' _�,, . ' c_0....... ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL 3Q0� Q 'l Z� 7 a frontage drawn to scale. <br /> NUMBER �lJt/S — 31 1'�)a1—V G $C.Z. <br /> TOWNSHIP' SECTION: 1 _ OF'WA:` S\ ❑ Driveway permits <br /> ►Ntol=�\�r) SE /<: st (state,county,town) <br /> ADDRESS: <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> d`1'f k�w + 1121i O u ,e.. (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ...-- '-., ,.."-, :,_ -` -, `r :C. <br /> • XT-his project is a new building or structure. t c i <br /> ❑This project is an addition/alteration to an existing building or structure. - r- -- <br /> SANITARY SERVICE: PERMIT NUMBER: Alt a sl 3 .? <br /> ❑SEWER .SEPTIC 6113 q a a a 'y =,:-:, - <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) � � <br /> 34 - 'I 1 Z— a g 7 t{is <br /> AREA TO NEAREST SQUARE FOOT: m .- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST I ® 4 7 : <br /> Has 4 3110, 4, TOTAL SQUARE FOOTAGE: ,, ` ad -�a <br /> 2ND FLOOR: 3RD FLOOR: , �� = <br /> I gen 10 lizA cts-Li tt 1.-1,44J,iiii:A.i1WAP.:: <br /> ESTIMATED CONSTRUCTION COST: <br /> ((Please round to nearest dollar) -0 -0 . -0 -, - - g <br /> ) COW O O � >:_.. L-,-2-1,,-.7 <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? 'es tlo LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes XNo <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 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes r o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -► <br /> 545-112(4/08) <br />