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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> 01 LAME /� <br /> "?n. A n. ; S • (ay i ciro ❑ Zoning Status;CUP* <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed R on;CSM <br /> JO S-1 V E't✓!nQ PC( v-e • ce(# ) <br /> *ME PHONE CELL P ONE E-MAIL ADDRESS <br /> (0Y trYE–i ca- 60e -�y - 957g cloodkr-cke, @ Cei vc 7'el.-Alet v Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Si a Plan incl ' 1ec on <br /> — <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> septic <br /> (City,State,Zip) (City,State,Zip) — ' Setbacks <br /> PHONE PHONE ❑ Site Pla oval from <br /> �p{�f cable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ o ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ` CREAGE: P P rty <br /> (�PARCEL n frontage drawn to scale. <br /> NUMBER 8���©q0 Q "3 SN-aa4a7 /c-�� ��Cl g <br /> TOWNSHIP: SEC 10 : <br /> I n �: .S� wh, I `� ❑ Drivew pe <br /> '�'' 4 county,town <br /> ADDRESS: // // --k'COLO' `y town) <br /> L-G 5-‘ V / f nn ce 0r i v 2 - Wez t-n 'Ice f, l S.35 9 7 ❑ Sanita mits <br /> CSM: LOT SUBDIVISION ! BLOCK/LOT (p • ,private) <br /> 3 kr'q�oi7 "..0/;,_f <br /> PROPOSED PROJECT INFORMATION x : ,R <br /> PROJECT DESCRIPTION: . , <br /> �S�ctc w■ (If-, O2 VQ. ;- <br /> . [4 This project is a new building or structure. :„..,-;. ,� .77",.. '; <br /> ❑This project is an addition/alteration to an existing building or structure. : �, <br /> SANITARY SERVICE: PERMIT NUMBER: q°eg,-5 1' <br /> KSEWER ❑SEPTIC + § s <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) _ <br /> / <br /> AREA TO NEAREST SQUARE FOOT: , ., V <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '. <br /> BASEMENT: 1 LOQR: 3 _ ; �. <br /> 3.2 <br /> ' 3 ) „ ,..t 4, TOTAL SQUARE FOOTAGE: ,�, �. ,, 7 a <br /> I �� . .�, <br /> 2ND FLOOR: 3RD FLOOR: � �� � �� � � .• <br /> ESTIMATED CONSTRUCTION COST: o p 6�" <br /> (Please round to nearest dollar) ♦ ♦ - ' ♦ ♦ ♦ $ 1000 • . , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? U Yes arNo LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes &iNo ❑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 gNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blanf none) <br /> 6. Is a location survey required? (see reverse) ❑Yes V+I No 51Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► <br /> 545-112(4/05> +� , <br />