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5c( <br /> LS S 5 .-7. 1I2 <br /> 4� ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUS MER TO PROVIDE <br /> OWNER NAME <br /> Ke_n Stt 'E-m b- Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> ]to VS To.-n, 6 S1-c \er Ti I t Stu„ 1 p 1 tt te, VOX 535.• Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (a(j g`g31473.) (c6$-c37`1-51"6 4 Vt @ SmidtyvIa , u S Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR guo yt,iL eN6t.�.(` Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (Ci ,State,Zip) C Setbacks <br /> [uPsi6 ti if 5.1/Z S <br /> PHONE PHONE ‘ -ite Plan approval from <br /> ((pog LjcjS= CO7 '7 2 ' applicable township. <br /> E-MAIL ADDRESS E-MAILAA,DDRESS <br /> CJ act q c:: all; VF;or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ NUMBER 0 10/0/11` !a) o)15b, A - 1 1 , 19 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: ■ <br /> B r` S�'b ,/4; 1/41/4_ E a riveway permits <br /> ADDRESS: _ (state,county,town) <br /> lo 4i, 1 arr% 0 Silc -t4er 1 (4, SIAA. Pratc..e, wT 6S5`tC1 anitary permits <br /> CSM: LOT 6 SUBDIVISION BLOCJQLOT ,�1 <br /> ( r ublic,private) <br /> ul I .4 C/— (p <br /> PROPOSED PROJECT INFORMATION <br /> 'J,'-'?'--„,*, ' ' -i..-,- I <br /> PROJECT DESCRIPTION: � ��. �,, .,£ <br /> aC i_5-_ c 'p__ • - °� � .; A <br /> 5a This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. _. �� _ }1, ,. <br /> SANITARY SERVICE: PERMIT NUMBER: ' a o <br /> ❑SEWER SEPTIC ( :" -. s i° , . <br /> r <br /> HEIGHT IN FEET: f NUMBER OF STORIES: (Not including basement) h ': - �� <br /> .cf Spy i - ' ��' _ Z"x W <br /> AREA 0 NEAREST SQUARE FOOT: '" -:� r <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` " ,, ., <br /> - : a a � <br /> BASEMENT: 1ST FLOOR: ,� , �; <br /> sg- 4, TOTAL SQUARE FOOTAGE: 4, A s . <br /> 2ND FLOOR: 3RD FLOOR: � - <br /> s <br /> ESTIMATED CONSTRUCTION COST: r �'��° <br /> '- <br /> (Please round to nearest dollar) -► -► -► -p -∎ -► �� � <br /> �1. T/k. Perty is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't know` <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes gNo ❑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 ❑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) NYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [S(No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545-112 14/08) <br />