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L-S <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUSTO ER TO PROVIDE <br /> OWNER NAME, <br /> "'a-C14 I '4V--' e ( pct_r n Zoning Status;CUP; <br /> OWNER ADDRESS (Number,S reet,City,State,Zip) ( Deed Restriction;CSM <br /> Z 2y a �.n- cites )l�vTi� (O('�' Var.', ce(# ) <br /> HOME PHONE �y CELL PH ON�_ E-MAIL ADDRESS S >2 <br /> tr Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> EY1,� <br /> 'Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) L4: Setbacks <br /> PHONE PHONE 1 i S AV'=Plan approval from <br /> app' ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) e <br /> [3 levation of property <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: p p <br /> NUM ER 5% 811-1 4-1.R-+Ow ca--/-0 a y 7 I fro tags drawn to scale. <br /> TOWNSHIP: SECTION�j /� <br /> 0 b 3-I 1%: S(.�.) 1/4%: (1 !1 .eway permits <br /> ADDRESS: . (state,county,town) <br /> 22!-(Q ,Q-Ql oas C L.4- c.t, _ ca, Uove_t wr <br /> t! ; . ry permits <br /> CSM: LOT St7BDIVISION BLOCK/LOT -pu•lic,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: , ' „ ` ,Po'3 <br /> This project is a new building or structure. 44,s` ' <br /> ills,. � <br /> This project is an addition/alteration to an existing building or structure. s <br /> SANITARY SERVICE: PERMIT NUMBE': ti" I' , -„• �, 'f , <br /> ❑SEWER SEPTIC ' .7 a r� F4 <br /> HEIGHT IN FEET: 1 NUMBER OF STORI S: (Not including basement) �� <br /> ® ergs. A <br /> AREA TO NEAREST SQUARE FOOT: A <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) K "�' <br /> BASEMENT 1ST FLOOR: ® 1 1 <br /> -� , <br /> -`i :`1,7›...,...,41--ad �� ie . ° <br /> 4, <br /> TOTAL SQUARE FOOTAGE: r <br /> t a f <br /> ESTIMATED CONSTRUCTION COST: n - , aY�(Please round to nearest dollar) $ / F vo C� o "^; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I_YNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? •#es UAlo El Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? El es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 114 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) Wes El No ❑Don't know <br /> 7. Is this to correct a violation? - e ‘; 1-0A.20-• , , r 1\\O ^ 14Yes ❑No <br /> 9 <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -► -► <br />