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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 /> y Aii A ,v;;,„:e14 4/I/c-6:y <br /> Zoning Status;CUP; <br /> OWNERADDRESS (Number,Street,City,state,Zip) Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAILADDRESS _ <br /> 6d'Site Plan drawn to scale <br /> AGENT INFORMATION CONTRA_ CTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA2T OR NAME <br /> Kr-../4 M1( t /15 i- - 7�te <br /> Plan Including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> i0..,\ `. --7 3o/c. 4i2. <br /> (City,State,Zip) (City,State.Zip) _ i Setbacks <br /> PHONE tr1?C4. :11 -T tj I,l, - - J.5 <br /> PHONE — Site Plan approval from <br /> ` ' - r,,.,'_ --? - .'.f1 ,p•licabletownshi•. <br /> E-MAIL ADDRESS E MAILADDRE 'I/ � `�� <br /> t''t, I J R; ►r_� t' ,, 7� '� �L i'Floor plans to scale I�- <br /> PROPERTY/LOCATION INFORMATION (http://acaessdane.co.dane.wi.usf) <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: ''/.evation of property �yt <br /> ❑ PARCEL �/ 3 frontage drawn to scale.fr”' TU�•,, <br /> rill D�JoG-Z�(-S.�?j�� A7/./ �. �7 g �-`l�' <br /> TOWNSHIP: SECTION: <br /> frkii •z0p 1;;I-. C 2-1-q-6 1/a: NW 1//1/4: Ng. perm its <br /> ADDRESS: 9 J J67 hew / -` 1 J „ pKriveway(state,county,its 2 <br /> ,�I/ L� .:.nits •- u its Lchev e -e,. <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publi• privat: 0 _ <br /> PROPOSED PROJECT INFORMATION .l.�rP-[ �{(IEVy ^\ <br /> PROJECT DESCRIPTION: `Y <br /> ),&e) .'�'� !i( �?%i! �, , ,% / ?r"rii % S LID lung Distrl t <br /> • t This project is a new building or structure. el , <br /> �µ <br /> This project is an addition/alteration to an existing building or structure. - —_ <br /> SANITARY SERVICE: PERMITNUMBER -0 RL1r_$1Adle'' _ <br /> SEWER I.a SEPTIC - (fl WC ISf1h_g <br /> HEIGHT IN FEET: YC^ � I NUMBER OF STORIES: (Not including basement) l` #�ndFlgodpin� <br /> AREA TO NEAREST SQUARE FOOT: <br /> S1ili and tattabhment z <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ♦ _© Er 4Ot,Q:-00 <br /> e <br /> [l►I <br /> t <br /> k ��1ST FLOOR:S VVVNX � :4.114.,:4114,°S (S oltto.141' ,j TOTAL SQUARE FOOTAGE: . ss2ND FL O 3RD FLOOR: lgreet <br /> 7G�� �6 k eeaoe i-M-0:14 andvalab� pofiE STIMATED CONSTRUCTION _, _I. ...o. ...0. -► $ 460 " ()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 Ul 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 ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0 Yes tiZ9 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) ❑Yes I No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> . APPLICATION MUST BE SIGNED <br /> 545-112(4108) <br /> (Continue on Back) —0. -+ —Y <br />