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2)____1 i'-) 4 ��3 rim. <br /> Vi (27k.,?( . p 473 <br /> ZONING ERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1+4f 1l' `GM C2-'t p)e •"S iC-` Y" ring Status;CUP; <br /> OWNER ADDRESS Es (Number,c- >City,sPce5s SP \ 55961 Deed Restriction;CSM <br /> w Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS L � <br /> ii P r• 5eC AA:: DEC-) Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> >7CoGe CLr2,404 .-7L/Uh GikSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 9--q..2 3 r*7ark.)-77c.cc der 5k, . <br /> (City,State,Zip) (City,State,Zip) 1311 Setbacks <br /> PHONE PHONE Ite Plan approval from <br /> Go - 7/a- 7 51 y applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 'pia ber ��Q�iC�eSf C°''7 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARC_LNUMBER: CURRENT Z NING• ACREAGE: P P rty <br /> El NUMBER 0: d-1022-0 v 254 outage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> � ts\441. 4/w y4• N 1- ,%,/: • Driveway permi-- As\k <br /> Z'(13 • I <br /> ADDRESS: �7 /4 j (state,county,town) <br /> ',S ( 2-- , tA0 r j S �a`s 5 r Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> y G ci7(k-c` kn.,i (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: �� . - <br /> tiw y £ <br /> • aThis project is a new building or structure. r ®$ {r <br /> ❑This project is an addition/alteration to an existing building or structure. ':-g �-4 <br /> SANITARY SERVICE: ��tt PERMIT NUMBER: e f � 1' ! '11'=:, °. <br /> ❑SEWER ;ASEPTIC S I e1 b la r::" ,� _F a 4 „ <br /> HEIGHT IN FEET: 20 P NUMBER OF STORIES: (Not including basement) - <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dim nsions including unfinished area,attached garages and above grade decks or porches) '� R <br /> # <br /> BASEMENT: 1ST FLOOR: <br /> 1 1C 6 7 Z j, TOTAL SQUARE FOOTAGE: j - !Ntr i,4 <br /> 2ND FLOOR: 3RD FLOOR: ( h '1 a � <br /> 0 �. <br /> ESTIMATED CONSTRUCTION COST + , ��22 : ,g, � <br /> (Please round to nearest dollar) "� •'♦ ♦ --► "♦ "♦ $ ,a e <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes 2 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Vi No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 12f Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes igi 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) >files ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► —► —► <br />