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L/7 S <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Q`G' A • 6 0 FE = Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 2Y5 L.-/ 5.4. t,' S'f .�'h F�nc;sca Ca -Y//C Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT/NAME CONTRACTOR NAME <br /> ,A)6 SoN cs)ehfia.I Co A-tit-tars L« Saµ^. . Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3256 11ruo k/yn Pc. • <br /> (City,State,Zip) _ (city,State,Zip) i Setbacks <br /> Sfi1L1)(4 W , X35 �°\ <br /> PHONE J PHONE ,■-' Site P approval from <br /> 60 e - 6 -/ SS/ cable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> `p loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ";11 Elevation of property <br /> PARENT PARCEL NUMBER: CURR + •ONI : ACREAGE: P P rty <br /> ❑ PARCEL 035 0 c S/ fro : ,n t. scale. <br /> NUMBER ?c 6 6I — t <br /> TOWNSHIP: /� -e, ` `SEC ON: 1/4 1 1 ' ❑ 1rivew- p: its <br /> ri <br /> '��� tate,c•• ry,town) <br /> ADDRESS: � ��� �� � C/� � <br /> 0f t'`/• ibn S. itary perms , <br /> CSM: LOT SUBDIVISION �, :LOCK/LOT <br /> Seat Aid • ■y� (public,private) <br /> PROPOSED PROJECT INFORMATION u .1 t t <br /> - <br /> PROJECT DESCRIPTION: ` � 1,1,--;,-- �� � ='-' <br /> New t oPe Ch 5 uLit Oil 3 1 _ Pf , :' <br /> • This project is a new building or structure. �r <br /> ❑This project is an addition/alteration to an existing building or structure. k- <br /> SANITARY SERVICE: PERMIT NUMBER: �t��:e 3 . �3 s '" <br /> ❑SEWER SEPTIC S 0- --)5 0, �a s <br /> HEIGHT IN FEET: , / NUMBER OF STORIES: (Not including basement) - - y <br /> AREA TO NEAREST SQUARE FOOT: [ � r �� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r F <br /> 2.2 G t� _ + TOTAL SQUARE FOOTAGE: + - P•,, 1. t , �- <br /> 2ND FLOOR: 3RD FLOOR: 6 m . <br /> W.:1,,� . t xT <br /> ESTIMATED CONSTRUCTION COST: ," , <br /> (Please round to nearest dollar) ♦ ♦ '♦ ♦ ♦ ♦ $ 3 Le)` U 4;4) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I{No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 21 No ❑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 rit-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) DYes til No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 5'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />