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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> rn � � 0 ISo•„ AV n Frsti:� ^_, <br /> �ZoningS <br /> Status;CUP; <br /> OWNER ADDRESS (Numbber,Street,City,State,Zip) Deed Restriction;CSM <br /> 1(Q 9d /- w y /3 57/0445X /61i 441-1 ..3589 Variance(# ) <br /> HOME PHONE CELL PHONE E- AIL ADDRESS <br /> 3 59-7g ..o 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION :nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME / / <br /> 3 �`vt O yflo r Sc.hcc,crsP,,- {1'1 o r Sc t-r�c,�Sr r /3c+ ,�4Z,5 XSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 135- ' �3�tr ✓, ;� 13sy8e„, P . <br /> (City State,Zip) / / / (City,State,Zip),-..n /d ����s?/ Setbacks <br /> t1J\ ?P-r- ; e !O'/ W. 5353 ,(V\�pr �P <br /> PHONE PHONE Site P n approval from <br /> (00 - Coy- 502_ S (eg (,9c • 77 Z 3 appl' able township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,]S Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn CA PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: CA Elevation of property <br /> 0 PARCEL fronts a drawn to scale. <br /> NUMBER dS'G-d!o!i ZS'y-qa/5 A /fJ` �es 37$4.kS g <br /> TOWNSHIP: SECTION: <br /> z.y 1/4: fw 1/1/. s w EN Driveway permits <br /> f e: 5 C n4 5Pr '7 s (state,county,town) <br /> ADDRESS: / <br /> /(O O hlw 8 57le v�S,(,4 4� wf S'.S� <br /> CSM: LOT 6UBDIVISION BLOCK/LOT unitary permits <br /> (pub'tircatio <br /> PROPOSED PROJECT INFORMATION e <br /> PROJECT DESCRIPTION: W 8 - c <br /> ❑This project is a new building or structure. . .- <br /> ❑This project is an addition/alteration to an existing building or structure. I. N, 4 <br /> SANITARY SERVICE: PERMIT NUMBER: '- hi ' <br /> ❑SEWER SEPTIC 57 O 9 �P ' mot-"g ,, S 4- - <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) -_ : � <br /> 2y / 4 ''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: �' <br /> TOTAL SQUARE FOOTAGE: . - ' ' ' - <br /> 2ND FLOOR: 3RD FLOOR: " O _ ' ' <br /> ' 7� Z� <br /> ESTIMATED CONSTRUCTION COST: - I� , ";g gr4 �,:. <br /> —0. —0. 9' ' —10 —0. K <br /> (Please round to nearest dollar) $ �� � �� � -.1,-&.:ti -. , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 2 N ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ca Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes WNo <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 J1 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®.No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —■' —► <br /> 545-112(4/08) <br />