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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 /> JJ 41� Je ice-( g�te,,-.c <br /> OWNER ADDRESS (Number,Street,City,State,Zip Zoning Status;CUP; <br /> Deed Restriction; CSM <br /> yo 3 L,-141 a i {-><� -c 4 1.1 c ? 5-7,1 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6oil-.)4s - 7/89 , G c �-S7S---7S3 K'at•-k-G",-C -;-7 ,p1c 7i- W Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S t D ea,/d(,S LZ P Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Pa 60X Z13 <br /> (City,State,Zip) (City,State,Zip) ' Setbacks <br /> -SP-25 Gre t,, 6.J.S s—_7<8s <br /> PHONE PHONE lI Site Plan approval from <br /> bog - 7 7 g-/c)ag applicable township. <br /> E-MAIL ADDRESS E-MAIL AD RESS <br /> S es�e r 4 e'ls@ G4€,4., - 44 I- pd Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARCEL NUMBER: CUR TZO G: ACREAGE: 0 Elevation of property <br /> Li PARCEL U j 40 47-6`J-$$30 0 / /, 1 ,3 frontage drawn to scale. <br /> NUMBER <br /> - TOWNSHIP. / SE <br /> 5 p-, is l P ex, '/4: 1\11,J '/4'/4: /I/t✓ 4 Driveway permits <br /> ss: / (state,county,town) <br /> 31&� e T L AJ Sanitary permits <br /> LOT SUBDIVISION BLOCK/LOT <br /> 11C/C19 L (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 45,1,4./,'4 ( CI Zoning District Q_� <br /> 44 ;This project is a new building or structure. Permitted ? rZ <br /> Li This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address j"'* <br /> ❑SEWER 'SEPTIC 3]V 0 c,' / (newlexisttng) I c€o <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �C <br /> a i 5 '' 1 ^ °dam 7 <br /> IOreland <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches)` <br /> BASEMENT: 1ST FLOOR: <br /> C."' <br /> 1737 3 3 C 4, TOTAL SQUARE FOOTAGE: , t$ • • -t- a m* ,_ - «.,[ <br /> 2ND FLOOR: 3RD FLOOR: <br /> L/ <br /> ?7‹A( 701 CI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: / Y and evadable options. <br /> (Please round to nearest dollar) ♦ "♦ ♦ ♦ ♦ ♦ $ 3 g 7 <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? Cl Yes ONo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes Li No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 41No <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 Li No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes WJo <br /> ✓ er-z APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ —► <br />