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, lq-73 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME AIL;y I' <br /> ) Zoning Status;CUP; <br /> OWNER ADDRESS Number,Street,City,State,Zip) <br /> �"/ COst 6-)C6,11;V1�g C� 3 Deed Restriction;CSM <br /> HOME PHONE CELL PHONE / E-MAIL ADDRESS �" �� Variance(# ) <br /> --- p ,2-65-4/3 -?c/s--- 16 ii rE Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 602c cu' - i cirY) Gc ;(k ' Ogite Plan including location <br /> AG NTADDRESS v CONTRACTOR ADDRESS of well/septic <br /> G .) g J tliPe.. &S3a2, Y;I,1(d—Y--,� al �wL- <br /> (Ciitty,State,Zip)1 (City,State,Zip) G ❑ Setbacks <br /> PD hx-1/e- ,u io yyta- 2i c -� l C-S <br /> PHONE PHONE 'Plan approval from <br /> ,a,-s---86188 - 8/8 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑ PARCEL 0J0 Y' °- 6s c frontage drawn to scale. <br /> NUMBER <br /> TORNSHIP: SECTION: <br /> 'own CS' T k ,�a. 1/4,/. nveway permits <br /> (state,county,town) <br /> 2 a/s ckj- c Itr _ 0 1�a. ' , , <br /> o-T nitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: YA ` _ <br /> AA i le., P S' 10 SI CL P 2,- <br /> a a & <br /> . ❑This project is a new building or structure. " ''. „k f,n <br /> A This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ,, , �' __'°ress <br /> .SEWER ❑SEPTIC �� : i $ �x <br /> HEIGHT IN FEET: /t . NUMBER OF STORIES: (Not including basement) •.. <br /> AREA TO NEAREST SQUARE FOOT: ~ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` 1i ,v6.-',:ii' ", <br /> BASEMENT: 1ST FLOOR: ' '' _ = <a � : <br /> j TOTAL SQUARE FOOTAGE: ,l, �,° �I jl'c <br /> 2ND FLOOR: 1RDFL69R"r . <br /> ESTIMATED CONSTRUCTION COST: ° , ,9•t <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ 45 <br /> 00 d . w :haw v$445 <br /> w -a.,,. a.u. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes --t1 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? ❑Yes ❑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? ❑Yes Z No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► --0 --0 <br />