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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 ftOVVI V t 12--t ci t t1 . 1 L-L Zaning status;CUP; <br /> OWNERt SS N umber.z• • City, le.L � l r Deed Restriction;CSM <br /> `� li ° ! .,t, 1t•eimi 1,(7.45- /' Variance(# ) <br /> H M CELL PHONE EMAIL ADDRESS <br /> �' "7 l r.I Site Plan drawn to scale <br /> AGENT INFORMATION p CONTRACTOR INFORMATION and includes dime <br /> AGENT NAME CONTRACTOR NAME <br /> S' W /15 416b V e to Plan including location . <br /> GENT AWRESS CONTRACTOR ADDRESS of We ptic <br /> • <br /> (C uv.s ay.z Zip) (tea State.ziv) tbacka <br /> PHONE PHONE III Site - -1 :•o • al from <br /> • app • •. •>wnship: <br /> E-MAIL ADDRESS E.MALADDRESS 21 plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:traccessdane.co.dane.wi.usi) eyatlonofpn3perty <br /> PARENT PARCEL NUMBER: CURRENT • ING: ACREAGE <br /> ❑ PARCEL frontage drawn to scale. <br /> - el ') OAS ._• Ka' _, A — • <br /> TOWNS1iiP: SECTION: <br /> `j rn - -Yi— ,/'y: ------- rlY�] YPermib -- - <br /> , -\4- fill - (state,county,town) <br /> `� ADDRE93: <br /> )--. . 1,&1. 0a)5 Ct 1 ( its <br /> CSM: LOT ri •':•rvMS10N BLOCKI.OT <br /> Aug_140 1 l �" p <br /> PROPOSED PROJECT INFORMATION <br /> PROJECTDESCRIPTION: •' ' <br /> . , /"' r .__ ,Gtj cv ns-t-r t.c..f;C, i . <br /> . L. This project is a new building or structure. . <br /> O This project is an addition/alteration to an existing building or structure. <br /> — . SEWER 0 SEPTIC -G/ - 000 �. <br /> HEIGHT W FEET`. ��-.1-5 NUMBER OF STORIEXNot including basemerd <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT. 1ST FLOOR: <br /> / f ` A-- 4.TOTAL SQUARE FOOTAGE: 4, <br /> 2ND FLOOR: 1, 3 `y 3RD F<••R: �/ 'r ' <br /> y <br /> ESTIMATED CONSTRUCTION COST: $ 4 , , Oa <br /> (Please round to nearest Mar) -•► ♦ -•► -o. -* -•► r �� <br /> 1 ate <br /> • <br /> No The property is within 300 feet of a stream or 1t>04 feet from a pond or take? .Yes 1NNo 0 Don't know '(( ..c <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1 No 0 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? (EYes 0 No <br /> 5. Is this project associated-with a rezone/CUP/variance(petition/appeal# ) (t ve blank if none) <br /> 6. Is a location survey required? (see reverse) LYes ❑No ❑Don't know <br /> 7. is this to correct a violation? Dyes LNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 .4 -!. <br /> 545112(4103) <br />