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qo <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> • 'NER NAME j� �,� <br /> ev r1 tS `� r8er' L Zoning Status;CUP; <br /> OWNER ADDRESS (M.Ltuber,Street,cif State,Zip) / Deed Restriction;CSM <br /> SOLVO h'// 1d v4 ^d/ CJZ Sci 7/ , Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ‘91 a IS (, 4,08 9 _ /S86, her-er e dL// C. O • E Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME �/ <br /> S1< ns av,te, Sows �'S o-e--,',, -," l� Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS �of well/septic <br /> • <br /> �, <br /> (City,State,Zip) (City,State,Zip) l`� Setbacks <br /> PHONE PHONE ftSiF JJte Plan approval from <br /> ap licable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CURREN ZONIN : ACREAGE: p p y <br /> ❑ PARCEL �/y frontage drawn to scale. <br /> NUMBER ON y O .2.Lo '-'9266 -S <br /> TOWNSHIP: SECTION: <br /> il.t.3rLt 4(e /4: Ih∎ srivewaypermits <br /> ' �� 1/41/4: S'� ■ <br /> (state,county,town) <br /> ADDRESS: <br /> 5a 3 (o Ft /14,,4 4 ci f'1 ad'.S d, w S3 7/g IF' anitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT `r <br /> 0 8s I (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PRO CT DESCRIPTION: <br /> DQ_t_IC r:?..:),Nt iotOrlii,N544'4,7_,_, <br /> XI This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. T' aA <br /> SANITARY SERVICE: PERMIT NUMrP.: <br /> ❑SEWER PTIC <br /> HEIGHT IN FEET: NUMBER OF STO INot including basement) <br /> 1 • •••• fit' :a <br /> 4� • r. a ,d-ter <br /> AREA TO NEAREST SQUARE FOOT: = , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) A . <br /> ,: I�Saall�:•, • $ <br /> BASEMENT: 1ST FLOOR: " <br /> 4, TOTAL SQUARE FOOTAGE: 4, a•` •t , <br /> 2ND FLOOR: 3RD FLOOR: ! a WO <br /> rilit re <br /> ESTIMATED CONSTRUCTION COST: • I a•aid•I•_ ' <br /> (Please round to nearest dollar) -. ♦ -+ -. $ 4.0/C00 1, y al <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes di No ❑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? Wes ❑No .-Ov 104A <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 04„No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes VI No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -► <br />