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w <br /> e <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER • ME �/J/J / <br /> flan /�� �` ( oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / eed Restriction; CSM <br /> / /6 Lt 1:),- , a c3 5 ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> -575— '7 , Ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTR CTOR,NA <br /> Ale,' �el,(V\ Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip) (City,State`,Zip) (( y ' � etbacks <br /> PHONE P E `��at- W� ❑ ite Pla pproval from <br /> 12DS -S,S-- .5-..7(P ppli le township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> i'!1 PARCEL Oa 2 /66�_33/_5W1)-7 4 iP _o ' ,,,/w 02 (p frontage drawn to scale. <br /> 4 NUMBER �/ <br /> TOWNSHIP: SEO w 1 <br /> Vera c ...... ' : f■\ 1/4%: ❑yvewaPeit( <br /> ADDRESS unty,tow I <br /> i /s Loc-a- 4 Dr- Sanitary permits e <br /> csM:OO�� LOT SUBDIVISION BLOCK/LOT (. blic, private) <br /> PROPOSED PROJECT INFORMATION REVIEW <br /> PROJECT DESCRIPTION: r / ' j <br /> Upjrct.Gt&C .4-icai) acid %)73( y t —L)thdrl%Qo o$i iTAFF <br /> ing District <br /> ❑This project is a new building or structure. 7 w mitted Use? <br /> This project is an addition/alteration to an existing buildin s ruc u e. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural <br /> EWER PEPTIC (new xistin <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> One-- ❑ tland/F plain/ <br /> ore d (attachment) 1 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: �C'' (2.., <br /> osionControl permit <br /> 1 x 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, ■ <br /> (I <br /> 2ND FLOOR: 3RD FLOOR: f fQ ' [ Review ding/access) <br /> Location Survey o <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ --► ♦ /� and available options. <br /> (Please round to nearest dollar) 0 16©6 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es ice♦ • ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es IN, o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? aes ❑No <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) [Yes Ef10 ❑Don't know <br /> 7. Is this to correct a violation? [Yes 10 <br /> r I '102 O APPLICATION MUST BE SIGNED <br /> 545-112(aroa) <br /> ^�►` <br /> Q (Continue on Back) <br /> t�' <br />