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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME �(' �/ <br /> `3 c -ni g�vifie Z ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,-State,Zip) <br /> Y/� 2 � ed Restriction; CSM <br /> 740 7 3 Si,c c /T/L e- %. . , "i2 o e,wy w/ s":?-rz J ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6 • a ; � u • e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION rid includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> a tA AG/7.y Lt/.$r ttwS T _17ct— a iL,7,/ 9r Gt>441 'K_- S. a Plan including location <br /> AGENT ADDRE S CONTRACTOR ADDRESS (well/septic <br /> R o. ab>c /7. 1°- c. T 1 Z <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> /t //b LA") s 3s-7 z Z <br /> ',z- C7t). ✓3 w► 3S'7 <br /> PHONE PHONE ❑S' a Plana oval from <br /> (t p '6.. 7 p' f _3 77, 6 Oc /d_ 177 / p is e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> / _. c of i Coq - _ , _-t - A. w _ ��- Fl or plans to scale• <br /> PROPERTY/LOCATION INFORMATION (httpd/accessdane.co.dane.wi.usn levation of property <br /> PARENT PARCEL N BER: y 1-- �+� CURRENTZO ING' ACREAGE: , P P y <br /> ❑NUMBER <br /> et''' < d -0 /� ' 1 frontage drawn to s e. <br /> TOWNSHIP: SECTION: ,�Q <br /> Q/j 6 On/ q " .1/4: ,i g- Y41/4. S = ❑ Drivewa rmits <br /> ADDRESS: U (stat ,County,town) <br /> . 15- Su CV 1 /Lt o :eL;V• L /✓ vY --�3-rz/'�'° Y 1 ❑Sa'Itary •-rmits <br /> CSM: O LOT <br /> / SUBDIVISION BLOCK/LOT <br /> L-. (p bli •rivate) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: if I` ' ,^ :yZ ing District <br /> . ❑This project is a new building or structure. V 1 mitted Use? <br /> ,This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 1 ❑ Rura dre s <br /> U <br /> FIEWER SEPTIC (ne exlstln <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including asement) <br /> / <br /> ❑ Wetland/ •odplai <br /> Shor- .nd (att. ment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR:' ❑ E •sionC: trot permit <br /> 7 VO ,, TOTAL SQUARE FOOTAGE: j (slope ,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: //J 4 /r'U� fillin: access) <br /> / <br /> ❑ Review Location Sury 0 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -► -► $ and available options. <br /> (Please round to nearest dollar) // v OO 0. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ®Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres 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 No ❑Don't know <br /> 7. Is this to correct a violation? Dies ®No <br /> . G APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 4 545-112(4/08) ( c) <br />