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a( q <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER T• PROVIDE <br /> OWNER NAME <br /> MA21/-/Morllc.A 6A2ntAki ❑ Zo m. «:tus;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,zip) Deed .1 ' tion;CSM <br /> ciI 1 KARL- f2-D bl.-PcUc C~rt12T N, (31-._ 53515 Varia -(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Ito g-?li7- t417 (501-333 --9g(,0 burmO.t\ 0.-1-46, bleb �. <br /> Ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR�iNFORMATION �� and includes dl'mensior} <br /> AGENT NAME CONTRACTOR NAME J <br /> v i‘Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) <br /> it -.-"- - . <br /> PHONE PHONE -;-,47461++' + •: from <br /> ..,t[':. -- . , . .i.. <br /> • E-MAI •.DRESS <br /> 4 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I levation of property <br /> PARENT PARCEL NUMBER: CURRE TZONING: ACREAGE P P rty <br /> ❑ PARCEL 0ao'1_2617.-93so-7 S R , 319 Ionto•edra to scale <br /> NUMBER I _ <br /> TOWNSHIP: SECTION: <br /> 3E21e� %V:R o? E ❑ D riv e, • +erm i•ts w <br /> n)9 . <br /> ADORFC¢. <br /> Cl 1 g I )A -1- R-D b i_rl-c. -t ,2 T14 oft 53 i 5 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ +I r.ry• rmlts <br /> ri(e Z 8 I `(pub l , • <br /> PROPOSED PROJECT INFORMATION 'ST IEW <br /> PROJECT DESCR93TION: <br /> �Wc l✓ toning District <br /> . EiThis project is a new building or structure. gASermitted Use? <br /> Li This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: _ NUMBER: Aural Address <br /> ❑SEWER ❑SEPTIC IA (n /existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I I t=EE r j 1Netladd/ (oOdplain% <br /> AREA TO NEAREST SQUARE FOOT: '� ttachent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' <br /> C d permit <br /> BASEMENT: 1ST FLOOR: ro <br /> I 0 Fr x t( F r ,,TOTAL SQUARE FOOTAGE: ,, (SlnprS,distur bance, <br /> fining/access) <br /> 2ND FLOC . 3RD FLOOR: <br /> .-- I tt 0 Fr. <br /> Oview Location Survey <br /> ESTIMATED CONSTRUCTION COST: d� fD !10 and available Options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ ► ,. <br /> 1. -i rle property s within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IdNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? , ®Yes ,❑,�,,'/NNo <br /> ll <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑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) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPUCATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -s• -s -s <br />