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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> C a 41C C.&r c1 \f of cs-/ O ' Aiv-t.V. <br /> OWNER ADDRESS (Number,Street,City,State,Zip ❑ Zoning Status;CUP; <br /> 7 _1 5- m�! �� � e Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL Pc -HONE 2 E-MAIL ADDRESS <br /> yU 7 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> OA 6C40 4)10(L V,_)b (u(X 4r— \'( ( .. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> SLR? )ow-Y Lt,,.-e ec� • 5 LI 0- 76,-1/4,4-f �‘r..1 f ck <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 1Y\1,rSkatl (A1 53SS9 ` tr-)kc..k.l L.,J 53SS`t <br /> PHONE PHONE ❑ Site Plan approval from <br /> (61) – Co 5-C— I X 3.) ((poi ) - L`L —61 a applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> D NUMBER d9 It -1 3a_g It o _ t P‘ I ,70 y frontage drawn to scale. <br /> U <br /> TOWNSHIP: _ SECT / <br /> (64- \'�o\ 1/: /V /a�/4; /(k,/til Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1--r? S M,'� CA <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 8 g C S tiM • (public,private) <br /> PROPOSED PROJECT INFORMATION :.1 : - II r <br /> PROJECT DESCRIPTION: a � <br /> 1t, a� C,ktacl-�J <br /> . aThis project is a new building or structure. u <br /> III This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 4:411,04, -1-47°''' <br /> ❑SEWER SEPTIC - _ --, <br /> �.. b yc <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including baserr�nt) �; . , "� ',� , <br /> }� <br /> AREA TO NEAREST SQUARE FOOT: y� t <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) P �` ` �� o <br /> BASEMENT: ��_ 1ST FLOOR: 3 Q7" �" � <br /> !V� 4, TOTAL SQUARE FOOTAGE: 4, , ,I fit' s , g � <br /> 2ND FLOOR: 3RD FLOOR: 3 F V -� �, �: . � �"r: <br /> 9.., , , ' <br /> aa <br /> ESTIMATED CONSTRUCTION COST: i," ` icYa 76 i s, '- <br /> Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 0 D . 6 O <br /> 1. The property is withi' 300 feet of a stream o' 1000 feet from a pond or lake? ❑Yes allo ❑Don't know <br /> 2. Is there a wetland or floo•• • -• • - - the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Li Yes ( 'No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? L -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) Li Yes ❑No LI Don't know <br /> 7. Is this to correct a violation? ❑Yes CNo <br /> / L) APPLICATION MUST BE SIGNED <br /> / 0 (Continue on Back) ■ —► <br /> 545-112(4/08) <br />