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... • <br /> S9 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 6R0 a C: `i L <br /> r 'pLoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> 1-1(30 C-ooko X 1iu i'RCV012. ,J6 cu S3CrS Variance(# ) <br /> HOME PHONE 6El-tPM6N6k..J t L E-MAIL ADDRESS <br /> /(--�_!d-I2�8 . • `— 2e "' Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION Site <br /> includes dimensions <br /> AGENT NAM /� CONTRACTOR NAME <br /> v�YeL/ 6. /j'7,/QOr Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7g'//w�De . <br /> (City,State,Zip) (City,State,Zip) cicSetbacks <br /> /Mad/50)1 LlOC. S37/ <br /> PH NE PHONE ite Plan approval from <br /> 10 ) c i � -aaa 9 ,applicable township. <br /> E- ADD RESS E-MAIL ADDRESS <br /> ail 4 r y- r• 64) /044/4`,/[014-7 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACR G P P rty <br /> ❑ PARCEL / rontage drawn to scale. <br /> NUMBER S0/46�/D--)63-0•26 c`oZ Q—I r <br /> TOWNSHIP: SECTION: <br /> Or�n10 .- Q6 ! e 14: <br /> S W ,/4,/: 02, ❑ Drivew ermits <br /> ADDRESS: (sta ,county,town) <br /> Lit 13O LOokuur WALL mC tflNb cur S3SS? ❑ Sanitary-,ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> a2s . aTE/2 ubt/OS 0 ..25— (publi •rivate) <br /> ' ; • ' • ' . ' I • ■ • ; u _ • . � ga4 s E <br /> �t �r - ti PROJECT DESCRIPTION: , <br /> . <br /> G 64-1£ . 4. ?f <br /> , <br /> Ca` ¢ 3�a � <br /> • fhis project is a new building or structure. � '�-,` �� <br /> ❑This project is an addition/alteration to an existing building or structures <br /> SANITARY SERVICE: PERMIT NUMBER: � ' • o ,, <br /> IIQSEWER ❑SEPTIC ,C ,: , <br /> HEIGHT IN FEET:, NUMBER OF STORIES: (Not including basement) ,,,,, �� . '�„ <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,.4 <br /> BASEMENT: 1ST FLOOR: T • ® likg • s <br /> • . ., <br /> 1 <br /> 4, TOTAL SQUARE FOOTAGE: 4, <br /> 2ND FLOOR: 3RD FLOOR: Q �� <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ —* ♦ "♦ '� "♦ 1),0^n 1 O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes t No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EtFlo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes allo <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 ❑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 />