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zP J eb4- <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUST MER TO PROVIDE <br /> OWNER NAME <br /> .)-olvn.;crn KEV L 1 v ■ G TR , GeONIC L• 4-Ge rNbci.'vWe S oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> '))064 (4.wi le Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 431- 3526_ ` at Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ��,, � <br /> GicO.rgC Is • W athu.5°'A To a t4a c K ` l ' to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 30Ctaco 14 w? 7S E37s?A U3 NN'7r / 6Z} <br /> (City,State,Zip) s,�S 7 4.. (City,State,Zip) Setbacks <br /> rill'. L- kveb t GU/ aytt.evi t fA.3 • <br /> s�r.�� saS�� <br /> PHONE PHO E Site Plan approval from <br /> al e e-- 47- 3 6'°t-s 66s-5 6,6.- 3308. applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> �^ /0D& S&-&-' 7/a,3 arFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: i ACREAGE: I���levation of property <br /> PARCEL i/ /qq✓:t:µ(12r'4. / frontage drawn to scale. <br /> ❑ NUMBER ��0/0' —OS --8i 7o / •' g <br /> TOWNSHIP: SECTION: 4 ( - I F. I�1 <br /> g L.0•E- Mo u K 0 5 01 1/4: 5 E +/4+/�: r( the,county,permits <br /> ADDRESS: <br /> (state,county,town) <br /> 3 O C G 6yffre 1.1 Gtr wa Y 7Fr <br /> - <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary•=. <br /> (public, •nvate) <br /> PROPOSED PROJECT INFORMATION -- ; <br /> PROJECT DESCRIPTION: -‘ ` Gff <br /> %j 'r a Twist VI G'as4QQ ao X 36 <br /> . &This project is a new building or structure. f � a �� <br /> ❑This project is an addition/alteration to an existing building or structure. _ � 5 <br /> SANITARY SERVICE: •.--• Al® ;:, <br /> PERMIT NUMBER: �..y �Y , ' 1� <br /> ❑SEWER ❑SEPTIC a 2 <br /> i If*.r ,Y Lx. b ��� <br /> HEIGHT IN FEET: I I �A�/� �� NUMBER OF STORIES: (Not including basement) ; r z <br /> 4 1I lyre ONES , �•t��•, , <br /> e,i--.,p® off® <br /> AREA TO NEAREST SQUARE FOOT: 71 = <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) i <br /> BASEMENT 1ST FLOOR: �, $ <br /> �, TOTAL SQUARE FOOTAGE: 4, }per, • �,L € t„ ������ <br /> 2ND FLOOR: 3RD FLOOR: , <br /> �ak . r ,75 V <br /> ESTIMATED CONSTRUCTION COST: ¢ = = <br /> (Please round to nearest dollar) ♦ ' ♦ ♦ --■' -► $ 9 �11 1 •0 0 �: ' • •• . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes C9 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes Etivo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Czl'es - ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Flo <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) DYes `rNo LI Don't know <br /> 7. Is this to correct a violation? ❑Yes &No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► <br /> 545-112(4/08) <br />