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1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 44Ae,., A ' ' bi ti <br /> Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State, <br /> 1657- 5- w Deed Restriction;CSM <br /> etio ?d Variance(# ) <br /> HOME PHONE C l PHONE E-MAIL ADDRESS <br /> 40; d13-7 :a Svn. -zma 72c Y,oa.cow, Et Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> / aik.) .4 sv,fi blu / I=',Site Plan including location <br /> AGENT ADDRESS �/ CONTRACTOR ADDRESS of well/septic <br /> 1657. 5. Y41 PcI . <br /> (City,state,Zip) (City,State,Zip) al Setbacks r j <br /> DettAeii G�J 53531 63/3d/fo/r6fa <br /> PHON PHONE Site Plan approval fronl(003) a(3 - 74$a applicable township: Ai / 4- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> w 78, c a 44/. co 4 O. Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: RI Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Cola e/'ov C '/4: <br /> %1/4: -Driveway permits <br /> ADDRESS: C (state,county,es) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> // (public, rat ) <br /> PROPOSED PROJECT INFORM_ALTIION f - <br /> PROJECT DESCRIPTION: 8 � <br /> . lirThiS project is a new building or structure. � ,� 7 <br /> ❑This project is an addition/alteration to an existing building or structure. $ <br /> 5 ,p <br /> t _::,, <br /> 3 4 3 <br /> SANITARY SERVICE: PERMIT NUMBER: a❑SEWER %SEPTIC 51soi - i �r r}°- a <br /> a <br /> ry •V -, <br /> HEIGHT IN FEET:d6 / NUMBER OF STORIES: (Not including basement)O^1 s <br /> r,,,..........`,•.. '''';V>.`.`'i <br /> AREA TO NEAREST SQUARE FOOT: -_ ,;- � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' <br /> BASEMENT: 1ST FLOOR: 'fi!' r <br /> l/O t �I�I(, Q p t -i, . <br /> 2ND FLOOR: 3RD FLOOR: �+�` �z+ <br /> ESTIMATED CONSTRUCTION COST: --- , L <br /> (Please round to nearest dollar) "'■ ""∎ --∎ —* $ ei(gds. 000, � ' <br /> 1. The property is with 300 feet of a stream • 000 feet from a pond or lake? LI YesJo ❑Don't know <br /> 2. Is there a wetland or o... . on or near the property? ❑Yes ..o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ' es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 180o <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 --124Elo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />