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• <br /> t <br /> SUPPLEMENT to Web-App# <br /> w <br /> ZONING PERMIT APPLICATION ww.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAL4E- 1 l <br /> Jo 1Vl` � LL ialiirTing Status;CUP; <br /> OWNEAC Q(Ng:�Street,�City,�to ,i& \ + �( t <br /> 1 �1(�\y Deed Restriction;CSM <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRES Q Variance(# ) <br /> i�j,` t ...66— i V SZ ` a ON r 15.0" O$P)an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFCA`RATION and includes dimensions <br /> AGENT NAME C NTRACTOR N L1 <br /> \..‘.- 1 C] T Z'C a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS � of well/septic <br /> (City,State,Zip) c( i ,State,ZiiE) p���\ �, etbacks <br /> �a <br /> PHONE PHONE Site Plan approval from <br /> (. 0 G D l'a c 3 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ^^, p <br /> PARENT PARCEL NUMBER: CURRENT ZONIN ACREAGE: n of property <br /> ElPARCELL ^ frontage drawn to scale. <br /> NUMBER I���I87���031�31oD"� C5 <br /> TOWNSHIP'. SECTION: <br /> l n 1/4: '/<'/4: ❑Dri a rmits <br /> ADDRESS: (stat ounty,town) <br /> 1-Not,l 1 , k-1\Ui WO4D C 1 CG LaJ O Sanit ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu c, ivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D SCRIPTION: ■ 1 <br /> rgpl �. W ls\ ,b t.,JL 1 c6oc5 c,AA.scce.k J- f 1 King District <br /> OThis project is a new building or structure. ermitted Use? <br /> Vt.This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rur. !`r S <br /> EWER EPTIC (n- /existin <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Jj Wetia dplainl <br /> Sh an attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attacked g ges and above grade decks or porches) <br /> zv- <br /> -BASEMENT: 1ST •OR: Ef0 CO o►permit <br /> I a o c �_:■∎: t 4 TOTAL SQUARE FOOTAGE: 4 (slopes rbance, <br /> 2ND FLOOR: 3RD FLO filling access) <br /> NN)..--k. d 4.% cip,N.0.1,-, 10 O Lion Survey <br /> ESTIMATED CONSTRUCTION COST: _ ♦ ♦ _ ♦ —11. <br /> �j� and av options. <br /> (Please round to nearest dollar) $ (J n/ <br /> YV0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes XNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes 21No ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? !yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes ®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) Ores ONo Don't know <br /> 7. Is this to correct a violation? Oyes a o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ <br /> 545-112(4/08) <br />