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ZONING PERMIT APPLICATION wwiv.countyofdane.com :...SUPPLEMENT to webapp# <br /> - `,; ` j .> u '. .: OFFICE'USE.ONLY:PROPERTY.OWNER:INFORMATION4- t. , <br /> OWNER NAME <br /> lPil..S \AQl <br /> I d--{4C- ❑ Zoning District <br /> OWN R ADDRESS (Nun et-,Street,City,State,Zip) <br /> \, _Q.'�►�'ll f��S t� ��v 1,� t.cJl 35 aj ❑ Permitted Use? <br /> PHONE E- ADDRESS <br /> r` (J- S— ).,—..„7, Ds ❑ Zoning Status; CUP' <br /> AGENT INFORMATION .:''. ,`.;` CONTRACTOR':°.1NFORMA ,IONS 5, ) j,; peed Restriction; CSM ,, <br /> AGENT NAME CONTRACTOR NAME Variance(# ) <br /> AGENT AdODRESS CONTRACTOR ADDRESS ❑ Slte Plan drawn,to scale Q _.__e, . antl includes dimensions <br /> (City,State Zip) (City,State,Zip) <br /> `� S' <br /> ' Jr Y(r p tR1 e W t jj.S <br /> ;❑ Site Plan including location. <br /> PHONE PHONE well/septic <br /> E-MAILADDRESS E-MAILADDRESS Q Seto cF, s, <br /> PROPERTYILOCATION'INF.ORMAT ION }''(httpN/accessdane:co:danewLu5n° r.t!`.' 'N{` ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONIN ' ACREAGE: <br /> 1 ^ +� appllcabletownship <br /> U PARCEL 1 t17"�71(0 -ci 000.. <br /> NUMBER <br /> TOWNSHIP: <br /> SECTION: 1 11 �' \ Q RUfal AddreSS <br /> lU 01 k...0 1A: '`�� '/41/4: W z' Knew.1.-4:0irg) <br /> 1✓ j f <br /> ADDRESS: ro <br /> ..� J� <br /> 1°°'p�,Q fir\ S� UG W 1 'S �5• Cl floor plans to scale <br /> CSM: <br /> LOT SUBDIVISION BLOCK/LOT <br /> t�Q"� a 1�( Q` U t 6.3 ❑ F1. vation.of property `' <br /> �1;Z•l�•F�d�Ed;l•rl� GI,1��]-k., E•1' ' .. '''''' frontage drawn to scale <br /> PROJECT DESCRIPTION: �' <br /> I I X.\� ��� ❑ Diiveway'-permits <br /> �� This project is a new building or structure. (Mate, county, town) <br /> ❑This project is an addition/alteration to an existing building or structure. Q Sanitary�permlts <br /> SANITARY SERVICE: PERMIT NUMBER: (plabliC,p(�vate , <br /> EWER ❑SEPTIC <br /> HEIGHT IN FEET: , i NUMBER OF STORIES: (Not including basement) Q Wetland/FIOOdplain/ <br /> 1 12 _ <br /> Sfiofeland (attachment) <br /> J <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,❑ ErosionCOntrol permit <br /> BASEMENT: 1ST FLOOR: (S10peS,thstufba(tce, <br /> TOTAL SQUARE FOOTAGE: 4, k a <br /> 4, <br /> filling/access) i' ` <br /> 2ND FLOOR: 3RD FLOOR: <br /> _❑ Review Location"Survey <br /> ESTIMATED CONSTRUCTION COST: $ oi� and available options N <br /> (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 a No ❑Don't know <br /> 21. There is a wetland or floodplain on or near the property? CI Yes Alo ❑Don't know <br /> 3. Have you talked with the township about your project? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0-Yes CI No <br /> 5. This project is associated with.a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes �No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes u-No <br /> IT MU B-E S <br /> (Continue APPL CA ION on Back)ST * 4.I GNED-► <br />