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a <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> OWN' 'ADDRESS (N mber,Street,City,State,Zip) 0' Zoning Status;CUP; /E:o< <br /> Deed Restriction;CS <br /> i/ZS buitJ k► ' k Avg 5Tou 6Nrb/0 Lt/; '5-5S4 j Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS I f l <br /> e L z <br /> 0. Site Plan drawn to scale / — <br /> AGENT INFORMATION CONTRACTOR INFORMATION -and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> HO/*lt 5,ecI46 5r — A86 A.Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (city,State,Zip) (city,State,Zip) Setbacks 7006- s-00 PHONE mr}v isold to i J c 3 7�3 <br /> PHONE PCSite Plan approval from /� <br /> 648 - Z SO -- q 'sa applicable township: / <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 'Al Floor plans to scale <br /> PROPERTY/LOCATION INFRMATION J(�http:/laccessdane.co.dane.wi.usn �� <br /> PARENT mr,r5 ,0V CURRANT ZONING� ACREAGE: �/€tevation of property <br /> PARCEL frontage NUMBER — I 6 1 ge drawn to scale. <br /> TOW IP: '/ SE •N: <br /> u h /c it✓- 0 y '► 1/i: -CW 1/41/4: 44V I': Driveway permit N <br /> ADDRESS: 7 s 1) k , r k 4 A V (state,county, <br /> CSM:/// LOT SUBDIVISION BLOCK/LOT '� Sanitary. ..a itS /1 f <br /> (public ' Y 1 <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: e d 1 r a, <br /> ❑This project is a new building o structure. 1 - ,, _t, } <br /> IA This project is an addition/alteration to an existin g building or structure. <br /> buildin ,� ,- $ � b <br /> SANITARY SERVICE: <br /> PERMIT NUMBER: °e -:.:=! <br /> ❑SEWER S • a f <br /> \, ': 3 R'. Fi'?— <br /> x1"4 <br /> HEIGHT IN FEET <br /> ifi-kb , MBER OF STORIES: (Not including basement) „it I k <br /> e Y,,ii a <br /> Ar �ST SQUARE FOOT:(Outside dimensions including unfinished area,attached garages and above grade decks or pot 1c�,i <br /> BASEMENT: 1ST FLOOR: ; w s $d "� C• <br /> ,I, TOTAL SQUARE FOOTAIP xC w a -- d e' '11,'" -, <br /> 2ND FLOOR: a :I a ,J a P ' ` <br /> 3RD FLOOR: <br /> M :-mac `r <br /> ESTIMATED CONSTRUCTION COST: � <br /> s A <br /> -o. --► -► ♦ --0 -► u s w e e <br /> (Please round to nearest dollar) ,) �, <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? Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes t; No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes NtNo <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 iNo <br /> Vin—/65/ Ex,t � I / <br /> 90 --/e52 S "mil 6 j 00 (CATION MUST BE SIGNED <br /> 545112(4/08) 9 3 /38 A ��� �s (Cont ue on Back) -► -► -.� <br /> ,� l <br /> o 1 - © � 9f .51- <br />