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. .. .........t <br /> , --,_ _-34 _.5--it <br /> r ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ID(0 S CZ- J) Eli ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ �- Deed Restriction;CSM <br /> (i 4)1� c.(11r5�t P M i_ >� �2Z. , L 5-3�S 7S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (Poly-(044- -18110 445-0' 2$ PICJ vUNi tE. GDO.5;t c s-COM ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> fb1(4 MO.)ALeda',Jo V-tc1I 6ciaoc./-IP.Dc2(o -pLyN r4 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> MJ4Zd4 ?f-,/,fi r-J55toO <br /> PHONE PHONE ❑ Site Plan approval from <br /> (000 .- �-- 4 S4 O applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> A/•ii-ritzA e' Crt.. t0 7 c_N4iT ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL /� p,., `�- - Ares 9 frontage drawn to scale. <br /> NUMBER V3�" '(�j�0''�'/��`U <br /> TOWNSHIP: SECTION: <br /> f 4 Q ,l,g 1O j ZG 1/4: N E %1/4:5 13,1-24 ❑ Driveway permits <br /> ADDRESS: <br /> ��� (state,county,town) <br /> eui4 0,3 9-''6-1) ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATIONT <br /> PROJECT DESCRIPTION: /� x <br /> 6-rots zog, etJ1 i..O/'� -�LG SU((- y . ?`kr <br /> L2I This project is a new building or structure. j r . � 4 `� <br /> ❑This project is an addition/alteration to an existing building or structure. -it,.- _ <br /> ' "(tee as;- v��'+ <br /> SANITARY SERVICE: PERMIT NUMBER: � Y� �'�€ <br /> ❑SEWER ❑SEPTIC a r <br /> HEIGHT IN FEET 1 NUMBER OF STORIES: (Not including basement) A <br /> 16 I i i9tRV I, <br /> AREA TO NEAREST SQUARE FOOT: . <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 '` `' , <br /> BASEMENT: 1ST FLOOR: � <br /> j300 4, TOTAL SQUARE FOOTAGE: , - .k.g ,4 -. , ,77 ' ' <br /> 2ND FLOOR: 3RD FLOOR: /� s - �_" <br /> 2 9a <br /> s , i6-, a <br /> ESTIMATED CONSTRUCTION COST: Q� ^^ oy 1 ° e _ <br /> (Please round to nearest dollar) -9► -► --► -∎ $ `TV 0 0 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes Vo ❑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? -Yes rr❑��No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Ia�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 INo LI Don't know <br /> 7. Is this to correct a violation? ❑Yes ial,No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - ' -∎ <br /> 545-112(4/08) <br />