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14 OC))/ <br /> ' ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> tJ Js p C7e,,vte T-4,1 (oi,-I y(AG Jo c S L./ L r'lr■ Zoning Status;CUP; <br /> OWNER ADDRESS (Number, r jet,City,State,Zi ) <br /> -325-6 kook. v- Or . Cpv�Aidi, ,� , 53�t9 Deed Restriction;CSM <br /> ( f Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6 6 Ci— / 5 PI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION .nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME ite <br /> AGENT ADDRESS CONTRACTOR 6RES�� 1 C,i4PC1�(5 LLG `L� '�fwell/septic i eluding location <br /> 7-2 5-6 }cup -Iy .1 hr. . <br /> (City,State,Zip) (City,site,Zip) g etbacks <br /> f:� <br /> 51-000 � i-r; 5-3s�`i <br /> PHONE PHONE `� = Site PIa approval from <br /> 6.6 q - i S S-y appl' ble township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> !2 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn _ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL L frontage drawn to scale. <br /> NUMBER �� b7b 0C1 6t7, A 1 ��� <br /> TOWNSHIP: _..A fin Lel on 1 SECTION: <br /> ' S F 1h: /3 r %1/: SGc �., 6 '4 Drive ypermits <br /> ADDRESS: � 5,-04 ` _ /�� . <br /> (stet ,county,town) <br /> CSM: LOT 4BDIVISION BLOCK/LOT =nitary permits <br /> �- Jr' e. 7 <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: nn / , � $ .az- <br /> ,) <br /> . This project is a new building or structure. -415� `� <br /> ❑This project is an addition/alteration to an existing building or structure. -4 <br /> SANITARY SERVICE: PERMIT NUMBER: ~ g,e a o <br /> ❑SEWER SEPTIC 5/ D6 5 44 .' <br /> HEIGHT IN FEET: �� NUMBER OF STORIES: (Not including basement) r:/-1A,1 4 S� � <br /> s"T." arpz3 t"4g. <br /> AREA TO NEAREST SQUARE FOOT: ,� �F' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,;. <br /> BASEMENT: 1ST FLOOR: , ® m ; <br /> ' 3 Q _s 'Z Z'O 4, TOTAL SQUARE FOOTAGE: 4, �r, -a �:Mtz,7".9�� ., <br /> 2ND FLOOR: 3RD FLOOR: ` <br /> ESTIMATED CONSTRUCTION COST: r ms_ , i <br /> (Please round to nearest dollar) ♦ ♦ ".' "♦ -+ $ 0 Q b L� <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? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ' 1Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 10 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 V Don't know <br /> 7. Is this to correct a violation? ❑Yes -Iirt Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />