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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 a: . // 1 .� ,�.-- <br /> i5of,. 6th/CZ-I Co A 7 4 61;(5 II G ❑ Zoning Status;CUP; <br /> OWNER ADDRESS Number,pi-get,City,State,Zip) CC ) Deed Restriction;CSM <br /> HOME PHONE a Coo kd1LLPHONE I"( S/O gl✓Yl%D 5-1 1v I- 3-)S- 9 Variance(# ) <br /> 60 S - 6 t cf-1 S5`( ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGES ME CONTRA CTOR NAME A'else ii N6/SDA1 / h'<,,./ C /(-f <br /> rs ❑ Site Plan including location <br /> AGENT ADDRESS ! CONTRACTOR ADDRESS of well/septic <br /> f ^ <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER tf 3)f1670 0-6 i- <br /> TOWNSHIP: x`02.3_0 SECTION: <br /> /Vi ld/ f S 6 ❑ Driveway permits <br /> `<- ah ��'' ����`' �-- (state,county,town <br /> ADDRESS: ( ty� ) <br /> 73y ce_lit,�(0,, rd, <br /> CSM: LOT SUBDIVISION BLOCK/LOT - ❑ Sanitary permits <br /> 3 ,h ref (Ltd f_/ (public,private) <br /> 5-, <br /> PROPOSED PROJECT INFORMATION 77775-,: -. <br /> PROJECT DESCRIPTION: :-' s °s :, <br /> • 14 This project is a new building or structure. ., i�:� r 9 <br /> ❑This project is an addition/alteration to an existing building or structure. _ .7z <br /> SANITARY SERVICE: PERMIT NUMBER: Y" e a c <br /> ❑SEWER i SEPTIC S I ; d A k °i a -, <br /> HEIGHT IN FEET: ..7 NUMBER OF STORIES: (Not including basement) w4, �' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) $ " �€ ' e '°; <br /> BASEMENT: l 1ST FLOOR: i(341 s a s ,, a : <br /> i 9 j a ,, TOTAL SQUARE FOOTAGE: 4, ,a 9.° ai a ,k <br /> 2ND FLOOR: 3RD FLOOR: ' K�Y� �: i <br /> 7 °3 h a <br /> /565-' N s a d ,;;;;,*,14,!i. <br /> ESTIMATED CONSTRUCTION COST: Q� * fix: ,t <br /> ^'∎ '■ ♦ "9 .... ,�,` 4 9 - 4 9TH `"�,v'=�z, <br /> (Please round to nearest dollar) $ ) SUS C!G b � . � > <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IgNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ONo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes IgNo <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 CarNo ❑Don't know <br /> 7. Is this to correct a violation? LI Yes krNo <br /> ve APPLICATION MUST BE SIGNED <br /> 5—C1 (Continue on Back) -+ -► —I► <br /> 545-112(4/08) / 0 C) <br />