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f- f <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> cT1 t t-C 5 LP1I.16 F6 Lt-r ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 63aa. .cLr 00 0 Ave M\ otz tQtJ WI C3S62.. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0:-4:(4A-31 ' CC v�c‘CC - ck.4 d 0 r^a L C.O r" ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> th\6 S 1k t J PM t1\ S\e'4w '(3vI1.11 1 N (3 et DeSI . 4 "Zt e , ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> '21 S' Dte( Po∎(N.'"r Oc v4f MS Oeer Po,A4 Acive <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> n70∎16ortoo t ti *T589 sYOv6.NrraN , 0.v f:Js. ci <br /> PHONE PHONE ❑Site Plan approval from <br /> 608- i377—113 \ 6018-217- 11'3 t applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ChC;s € S\0..4Jbv tickt e s, co r■ cke,v „ S1no,,, 5 01i o Zrs ,corn ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/ <br /> PARENT <br /> ®PARCEL <br /> PARCEL NUMBER: pp.� '�yy CURRENT NI G: ACRE/ `C <br /> NUMBER o'�a6" 36(- 82 ..o 3 �� <br /> TOWNSHIP: SECTIO C .flQR AEG{G <br /> V CO.\ MIT 1/4: epo_fte <br /> ADDRESS:5_/ 7 If e7//- 3e- <br /> CSM: ,3 <br /> 5 LOT SUBDIVISION BLOCK/ <br /> xl b$ rCS <br /> PROPOSED PROJECT INFORMATION Mb,IN �LOOiZ.. <br /> PROJECT DESCRIPTION: 1 ��' <br /> , sE, 4, (,E. E x960 <br /> . <br /> This project is a new building or structure. PECK <br /> ❑This project is an addition/alteration to an existing building or structure. Cc�Vti�CtfJ <br /> OEtK = Z66 <br /> SANITARY SERVICE: PERMIT NUMBER: �+r, � ,/ _ + <br /> FIEWER Ft EPTIC \3—20\1 ^00\9$ to Rt fiN Eel f' I 1 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including bi -7 c .-?.7 <br /> Os ' Shoreland (attachm ent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionControl permit <br /> a3►5 3 5 3-7 j TOTAL SQUARE FOOTAGE: IF (slopes, disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 5-8 50, <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: —• --+ ♦ _ ♦ and available options. <br /> (Please round to nearest dollar) $ SOO 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Ekes "lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes 'lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres lao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes a. <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# d ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes a. ❑Don't know <br /> 7. Is this to correct a violation? Dies NNo <br /> CO ` 6 ZO(1 APPLICATION MUST BE SIGNED <br /> Div v� ,I (Continue on Back) -. <br /> 545-112(4/08) l <br />