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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME J�� v <br /> ZI $' %,E1?) ` �G1` 5 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) p Deed Restriction;CSM <br /> -? q D I ) Y TL Too fit t�bO ,AS , V ao,o A WE Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> EC33 <br /> 093-85 1/� 9 6 4 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME� CONTRACTOR NAME <br /> I I M teen es P_ova /O1L t) ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> x--76 MAof s- )I t` �✓ ?6 fir,,e7-r.ix Li zi. Zo • <br /> (city,State,Zip) (City,State,Zip) ❑ Setbacks <br /> C265S?LA 2 1S Loa_ 5 3 2( C PASS P 4 ,d 535.2 <br /> PHONE PHONE ❑ Site Plan approval from <br /> t)8 ;3q Q 1 6`4- b Oc ;' q -616?- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Kee Aey 09 rteiPavok•/l� . 5/4 c ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) <br /> PARENT qe,C),73LVJABER. CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL L A(s_D72 7/a�]3 a�j 2 frontage drawn to scale. <br /> NUMBERJwb >u i <br /> TOWNSHIP: SECTION: <br /> �Otr� l (f t�bclA kPe06-644_, <br /> 14: 5 i 1/1/:sail_ ❑ Driveway permits• <br /> (state,county,town) <br /> ADDRESS: (� <br /> )44r4 ��hl�d-B-pW6 K.-.'J u ozd,Jr W ' , <br /> • CSM: LOT SUBDIVISION r� BLOCK/LOT ❑ Sanitary permits <br /> 7 11PMIIID� . (public,private) <br /> PROPOSED PROJECT INFORMATION �1 <br /> PROJECT DESCRIPTION: • PM cY r r, `•�d` � ` ` 1 ; 4:--:1 <br /> •o .Apt �, ,,ps7e:od r .a.6¢,Ge14.6 AZT G,�r i b*C14tiY,-°A E P � .s r, L <br /> . ID This project is a new building or structure. � � , '114 s <br /> 4This project is an addition/alteration to an existing building or structure. z <br /> SANITARY SERVICE: PERMIT NUMBER: k <br /> ❑SEWER ASEPTIC 2' , : - �r <br /> HEIGHT IN FEET i 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) ,° '": <br /> BENT: IOW 1ST FLOOR: � .. <br /> 0 t�/�I MI 1 S' Fr TOTAL SQUARE FOOTAGE: �, 3 . ffii !. Y - �� <br /> 2ND FLOOR: 3RD FLOOR: <br /> �� � � � <br /> STIMATED CONSTRUCTION COST: 4 _`�g, <br /> (Please round to nearest dollar) "■ /j �Q DD <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 LI 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 21 No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> (76. Is a location survey required? (see reverse) ❑Yes 'No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICA MUST D <br /> 545-112(4/08)e) <br /> (Continue on TION Back) BE—► —SIGNE► <br />