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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER�JI AME <br /> '---,bhf\ 3Y0.10 . _S a a- , Z ing Status;CUP; <br /> NERADDRESS (Number,Street,City,State,Zip) (� rJ3 co - eed Restriction;CSM <br /> C0.��2.( I t 1o�Z.O(YI�D(\■t, \ ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 'I _1 <br /> ��g ,7 -Zi (v�� D' 0� �e✓ISeAl al-fJ,, ilL� Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Spxone____ OV1(\ --- Qf ZAjaC'h-Sev\ _.K 1 ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> e <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS V E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRE T ZONING ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL O O* -23 3 2-QC�V - ,,..% 3q frontage drawn to scale. <br /> . NUMBER L'Vl4 l� V�MJ <br /> TOWNSHIP: SECTION: 1 <br /> -6\c�c C"" <-. c9-. 14: N W 14,4: (\G ❑ Driveway permits <br /> AD�RES(�: C(,r� (state,county,town) <br /> v"'" k ( aocts_a ❑ Sanitary permits <br /> CSM: -�--■■ LOT i SUBDIVISION BLOCK/LOT (public,private) <br /> - ``�i <br /> PROPOSED PROJECT INFORMATION - FREVIIEW <br /> PROJECT DESCRIPTION: -. ®- V V V V V ; <br /> NQx)� 5 m\� v� Ces‘ck C-Q_ <br /> ;x , <br /> Xi This project is a new building orVructure. <br /> ' to <br /> ❑This project is an addition/alteration to an existing building or structure. y ���� , <br /> SANITARY SERVICE: PERMIT NUMBER:] �Q , !° I V '"V <br /> 1 1 —\1 ewlexisf�f w . <br /> ❑SEWER ASEPTIC � -� <br /> IV <br /> HEIGHT IN FEET: ` NUMBER OF STORIES: (Not including basement) - e;x , ' <br /> 1� r ,,..:,.::114441,..:4111.7.:A#s <br /> 0. ` rir ent) <br /> AREA TO NEAREST SQUARE FOOT: _ t k <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , 1fin r <br /> BASEMENT: 9 1ST FLOOR: 9 9 9 P ) IonCQ � V: <br /> Z\ C r� 2- \ 0 O + TOTAL SQUARE FOOTAGE 4, ,di a n :, - <br /> 2ND FLOOR: `J 3RD FLOOR: <br /> �� <br /> O <br /> ESTIMATED CONSTRUCTION COST: p <br /> O� c�a1VS�I�ItD Cb.t '_ <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ ZZ© ....co LJV, <br /> r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes L 1 o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Co ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? C 'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes ❑I loo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if <br /> none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Elio ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />