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ZONING PERMIT APPLICATION ww <br /> w .countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> NIvER NAME'' ff �� I W <br /> OW��ADDRESS'(Number,Street City,S te\Zi~ 1� l w Zoning Status;CUP; <br /> P) <br /> ` 47•x, FM bi 01-) noes 40�19 Deed Restriction;CSM <br /> `V/ !� Variance(# 35 9 ) <br /> OME PHONE CELL PHONE E-MAIL ADDRESS <br /> 410411"4Y`f 31, 339q 2l : Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> f , I L r ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • well/septic <br /> 41att iMc iA4-YLP, . <br /> \/ (,CCityyi State,Zip) �-�— (City,State,Zip) 0,P Setbacks <br /> lvtaldtTVIA t u S3-11C, <br /> PHONE PHONE P Site Plan approval from <br /> t'o$ 7 -161246 :pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 4CMSCheU ?5E3C—C L(1,41 Floor plans to scale <br /> PROPERTYILOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) :` levation PARENT PARCEL NUMBER: CURRENTZO ING: ACREAGE: evaon oproperty <br /> MEELR 002,66(2.-3104 09 Q 004 4-in. , i �� frontage drawn to scale. <br /> TOW SHIP A v l N IO ' <br /> 1 1/<:S %IA:kl _, j4 Driveway rmits fr,„q-{-e. <br /> ADDRESS: (state,c nty,town) 4.,,,,, <br /> rd ��` � D -I'tary permits ego% <br /> CSM: LOT SUBDIVISION BLOCK/LOT ()I <br /> Z a 7 k, :._ ..LA (o (pub •rivate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIP N: 1, � � . <br /> q} �- <br /> . This project is a new building r structure. = a <br /> ❑This project is an addition/alteration to an existing building or structure. , ,� <br /> SANITARY SE VI E: PERMIT NUMBER: F r t e s T <br /> CI SEWER ❑SEPTIC ' �,q n° a ; � <br /> HEIGHT IN FEET y <br /> lj NUMBER STORIES: (Not including basement) ' �e <br /> 1(� <br /> AREA TO NEAREST SQUARE FOOT: _ ate. x. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , „F -� <br /> BASEMENT: 1ST FLOOR: & 13 '''. <br /> TOTAL SQUARE FOOTAGE: tam k-” <br /> 2ND FLOOR: 3RD FLOOR: ® �� <br /> 2� C1 <br /> ESTIMATED CONSTRUCTION COST: ��� a '� <br /> ♦ ♦ ♦ —► OM <br /> —1(Please round to nearest dollar) —1 r C�I�tJ of . v `' <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? XYes ❑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? ❑Yes l(No <br /> 5. Is this project associated with a rezone/CUP ,•etition/appeal# S)1 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Wes ❑No ❑Don't know <br />` 7. Is this to correct a violation? ❑Yes Ciklo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br /> ♦ ♦ ♦ <br />