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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA <br /> eve- � !Ci ,4f/° e- ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> <'f?? 11/Wir 57 L�e- l 'ST,• x, ' 53 2— Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 049 9—(oo/0 772 '5E3 Kam@ Dress SF iikasrs cFr D,svrt//r6M <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NA CONTRACTOR NAME <br /> (/(S PV/5 51-661_ ./a L>0065 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3162 0410-D !90c De, 34re) at vOL 2 ea,e4< qs e <br /> (City, te, ' ) (City,State Zip) LI Setbacks <br /> PH E PHONE ❑ Site Plan approval from <br /> 6 N 0 --g7. 3 cAte 00 g — -Zl 3 applicable township. <br /> E- ILA RESS E- ILADDAESS <br /> 7)41/55 ' _tLrh'16,--. A r 74405SftE -e e 69,45e.JET ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ r-j frontage drawn to scale. <br /> NUMBER bin — 05� - 'cc-6) ( Z e 7 <br /> TOWNSHIP: SECTION: <br /> . (/1e(Ce 17c. 1/4: 5E %1/4: SE ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> Q 12 4 #(API- 05 t, `�7l2&T ltiL 53S3a- <br /> ❑ Sanitary permits <br /> CSM: _. LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION -� 7� <br /> PROJECT DESCRIPTION: - <br /> �D77 / -a a r -a, <br /> • '�, F� � Sc�c- �Phi rZ 'Gi t,+T`� � � <br /> 7i This project is a new building or structure. , - 1 . <br /> ❑This project is an addition/alteration to an existing building or structure. �$ , e <br /> SANITARY SERVICE: PERMIT NUMBER: -.ham W e• _ + �� <br /> SEWER ❑SEPTIC , - a a • ` 7 :_ <br /> HEIGHT IN FEET: JCS j NUMBER OF STORIES: (Not including basement) _ s <br /> AREA TO NEAREST SQUARE FOOT: '' , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) + , <br /> BASEMENT: 1ST FLOOR: 2 ® •! • ' 1 - <br /> TOTAL SQUARE FOOTAGE: 4, .• ,��qi a ; <br /> LI 2ND FLOOR: 3RD FLOOR: /may _ e -' .-� � . <br /> ESTIMATED CONSTRUCTION COST: / = _ • _ •a;f - <br /> (Please round to nearest dollar) '∎ --► -o. $ 1 ei �,CX_ =;,_..,- <br /> > �� , <br /> 'Ib Ea-I reFF_< <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? jaYes ❑No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? fil Yes ❑No ®Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? *Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI 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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes *No <br /> sS �cc 3 00_12 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -0. <br /> 545-112(4/08) <br />