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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME/}� <br /> 'n�K L SS Ee ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /AA [/_n Deed Restriction;CSM <br /> 510, L;� y � re6, &a 5 3 S 7c7 V riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / <br /> ,Q$'-q37-50� 6Jg-7/c?-/?o(o 2SSec,y)t'C etc Je►:tie 1-- S' Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME I� <br /> Retat/ 2 je Ras4 Si Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> US S. 5S2-- <br /> (City,State,Zip) (City,State, feb/�� 5 3 C 7� /Setbacks <br /> PHONE PHONE 7`/tl J S' a Plan approval from <br /> 6cg-f37_ 6 q6o pp' able township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS I <br /> fang A Z;eba(4l6u;(I . Con/ loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El ation of property <br /> PARENT PARC LNUMBER: CURRENTZONI ACREAGE: P P y <br /> NUMBER Ooy oJO707-/Y392VO o RR-1 17 8 c ' '83 fr ntage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> CM ?LA-INS as I/,. a 1/1/. AiE Dri eway permits <br /> ADDRESS: ( ate,county,town) <br /> Rae_ 14 1( Q/.� Cross Pk '4 toS 53528 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 0IVO 1 N , N : (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> rr* ��F1 E`ViEW0 <br /> PROJECT DESCRIPTION: f �i A,a <br /> N how �' ,�S u(4;a� $nrn� s �. <br /> . This project is a new building or structure. F i( . a <br /> lttsIyUss � 9 <br /> ❑This project is an addition/alteration to an existing building or structure. 5s <br /> SANITARY SERVICE: PERMIT NUMBER: :' t •°ess t '� <br /> ❑SEWER SEPTIC 5103 0 e i _ � , " <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not including basement) y 0 taint cs? I f X66 <br /> V 4Vrelland attachment) <br /> AREA TO NEAREST SQUARE FOOT: F <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t ii <br /> BASEMENT: . 1ST FLOOR: �' � �pel'Jlltt <br /> �^ TOTAL SQUARE FOOTAGE: 4, 5 t•es�, turbance, a <br /> � x <br /> �{ o�(�� 3 0 '' access <br /> 2ND FLOOR: f7 3RD FLO��. /� Ai' o F e <br /> ESTIMATED CONSTRUCTION COST: p "S ., 'lilt:4:1:06 .4:Z;':-.., <br /> (Please round to nearest dollar) ♦ ♦ ♦ '♦ ♦ ♦ $ .• 1 13O. ` ," �.f irp ,,,;;;;;:k .,... <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? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i ne) <br /> 6. Is a location survey required? (see reverse) *Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes fa No <br /> / 37�. APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br /> PuAll a17. <br /> DQUL. 5 Y3 <br /> y <br />