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/4ccdi\erYk 5 <br /> 4 Al <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> '✓d r) 6O` d(' I ehlieeg ning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) C� Deed Restriction;CSM <br /> 1� �6 STOIC, 1�doeq Dei vt' � (�()ramie 53C/ L ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ■ 4_ 2o 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION .nd inclu es dimensions , _ <br /> AGENT NAME CONTRACTOR NAME <br /> ZQ ec/ eeeg,e Cs ; '.is i e Ian inc uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> 6 4J1 nrJr-,,//,t',krPo <br /> (City,State,Zip) (City,State,Zip) Se cks <br /> / 6aee,s L/r .�3L"7¢ 14 <br /> PHONE PHONE 33 1 e Plan approval from <br /> 66 E -- 5) 7- 33 Z 0 ap licable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Fl or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) vation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL fronta•e drawn to scale. <br /> NUMBER I � '/O— ZZ"O 0 /—��� <br /> TOWNSHIP: SECTION: ❑ Driveway (_^/ <br /> But k t D z '/: /U ) WA: /O , y permits <br /> (state,county,town)ADDRESS: <br /> 5 <br /> , 3 , 6e ctd:cs Cfec <br /> CSM: LOT SUBDIVISION BLOCK/LOT •UbIIC,private) <br /> y 6 - k5 d og <br /> PROPOSED PROJECT INFORMATION <br /> � �PROJECT DESCRIPTION: - F <br /> V F �� <br /> This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. , ' , <br /> � ,� mo '' r y <br /> SANITARY SERVICE: PERMIT NUMBER: °s w V: <br /> ❑SEWER SEPTIC 12/ a ' <br /> HEIGHT IN FEET: 29 NUMBER OF STORIES: (Not including basement) <br /> Peill0 AREA TO NEAREST SQUARE FOOT: - x <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) & ' '9 BASEMENT: 1ST FLOOR: �P e a a <br /> ��I �J +, TOTAL SQUARE FOOTAGE: ,� r *®. �l $ <br /> 2ND FLOOR: r 3RD FLOOR: ' <br /> 3` = ova <br /> ESTIMATED CONSTRUCTION COST: � ,-" ; , $, a '', - <br /> (Please round to nearest dollar) ♦ ♦ "i ♦ "♦ '♦ 2� 00 Lag.- =,-, . <br /> vvv )V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes E No Cl Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes a10 ❑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? ❑Yes ErNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (lea e blank if none) <br /> 6. Is a location survey required? (see reverse) LIYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes CefPto <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► —► —► <br />