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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> W . Ill 4(AAAli, oning Status; CUP; <br /> OWNER A DRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> JD VI.09 /e. / o +)«, w'l 5-"3 4,0 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,/g.7/Z, $530 ,.:. ZR' .-76- 2. r' Al(-4_1.4-1 toI+e_► od vli• t°N'► S' Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S' Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ tic <br /> ,✓ (City,State,Zip) (City,State,Zip) backs <br /> PHONE PHONE ❑Site Plan ppr val from <br /> applica wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Flo plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevati of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER c%c=7 1 / 7/ 9 0cN/ —0� 7( O >[j 1 C,1 l\front e drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 1/4: 1/4,/4: ❑ Drive a its <br /> ADDRESS: (Sta ,CO nty,town) <br /> jcs `J/� LOT �1 142 SUBDIVISION BLOCK/LOT ❑Sanit-ry p- its —11./(-- <br /> ��� \ (publi •rivate) O <br /> a <br /> PROPOSED PROJECT INFORMATION ST F -EVIEW <br /> PROJECT DESCRIPTION: 'n <br /> Rest td-FA- ( 5- 7 6 1 d' > Zo ' g Di trict <br /> . rgThis project is a new building or structure. Per • ed Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural # e e _ <br /> . r)EWER [)EPTIC (ne , <br /> HEIGHT IN FEET: / (/ NUMBER OF STORIES: (Not including basement) <br /> I5t1 ©�� ❑ Wetlan. ... :in/ <br /> 77 / AREA TO NEAREST SQUARE FOOT: - - t-4111h ch - t)/ 1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) A ..SI Contro mit C� <br /> BASEMENT. 1ST FLOOR: <br /> 17�g j TOTAL SQUARE FOOTAGE: 4, (slopes, • rbance, <br /> 2ND FLOOR:2 3RD FLOOR: 7 flllln CC S) <br /> l Z� ❑ Revie at' urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ / l�.� and a • options. <br /> (Please round to nearest dollar) / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't kno <br /> 2. Is there a wetland or floodplain on or near the property? Dies fNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres ONo <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) Ekes ❑No ❑Don't know <br /> 7. Is this to correct a violation? Efres ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -s - <br /> 545-112(4/08) <br />