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I <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 11 FP - v" oning Status; CUP; 0� <br /> AWNERADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> V// /C157 6 ---.y (4)• 5u ' v¢,}„¢, i..1 Variance(# ) '��� <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> [ern drawn to scale 1D'r <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions nlvi <br /> AGENT NAME CONTRACTOR NAME <br /> CGC <br /> •4,4 da/vuo∎ ve cLtvc-P- Si an including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Ac., vAa�,5 T <br /> (City,State,Zip) (City,State,Zip) Deeacks <br /> / <br /> PHONE c ..PHONE ❑Site P -• -•proval from <br /> 371 -613 ap• ' - •wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> T t' CC(0)-(2'1"6-t v0,•'•'4 •4--,-- F r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) n Ele tio of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL 1 n ntage drawn to scale. <br /> NUMBER 6«/Oql l ^•h4 ^& i S /'Y� �� �.7.�•� <br /> JTOWNSHIP: SECTION: /Ma <br /> AiSa '/4: .'t,w 1/a1/a: S t ❑Dri way ermits <br /> ADDRESS: (stat ounty,town) <br /> /`1S7 G'uf'v`""Y &J, 1 anitary p rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> — (public�a� rat� <br /> PROPOSED PROJECT INFORMATION = ;.t :'" <br /> PROJECT DESCRIPTION: <br /> 30x :MRttttN4441/ 51ts> t <br /> . O'his project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> /TARYSERVICE: PERMIT NUMBER:ali <br /> EWEREPTIC �HT IN FEET: NUMBER OF STORyS: (Not including basement) <br /> 1 ' r <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 /> /lig t h TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: p , iis �" 4 <br /> ♦ — —, —, � -, <br /> (Please round to nearest dollar) fro <br /> r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des �lo ❑Don t kn� <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des 2No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des ❑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) Dies ,❑No EDon't know <br /> 7. Is this to correct a violation? ❑Yes ZNo <br /> AIAU BE SIGED <br /> 545-112(4/08) (Continue PPL C On TION Back)MST -► N-� <br />