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1%9 <br /> li <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /'P'C E '/LZ.--v ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> '/S AV. ---,.3z.-e' °,,-,/c_._.5- ,/,1-ve-7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ..•2 1"/ -e7 2 2 o2-2 G‘G./ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> //e-l--7 e--.i'4,-.E-- - ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ..2. 9, /9-s`7-e) / , ,p . • <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> /y 4• /so/t/ - S-3 7/ 3" <br /> PHONE PHONE ❑ Site Plan approval from <br /> (6U,} ‘.2,- ,f,r Yy applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURB TZONING: ACREAGE: P P y <br /> ❑ PARCEL nn n ' frontage drawn to scale. <br /> NUMBER l,7/o S 1 on 11 n - ' . 3 1 <br /> TOWNSHIP: SECTION: <br /> .QLO/,-7/..tv:‘ 6,t'a, O S '/: N-_ '/< : N ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> " — �qi e' Q,q-,C� g vE---; ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION T "-,� 111/3 �.; <br /> PROJECT DESCRIPTION: • , <br /> ,Q�� O.�C�C /I A'/D r avi7&' seaa� : <br /> SC:.mss:T-'T <br /> ❑This project is a new building or structure. <br /> ,This project is an addition/alteration to an existing building or structure. �' . <br /> gym' <br /> SANITARY SERVICE: PERMIT NUMBER: '® = <br /> El SEWER ❑SEPTIC -`eq - n >." 4 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: zt: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) g �i <br /> BASEMENT: 1ST FLOOi� c <br /> `} <br /> 4, TOTAL SQUARE FOOTAGE: 4, ' ° so\ <br /> 2ND FLOOR: 3RD FLOOR: I �, ' 2 ff. " <br /> ESTIMATED CONSTRUCTION COST: , ' , - 61 K.. ' <br /> ♦ -► ♦ ♦ -► -► $ 6-aaG, oG <br /> (Please round to nearest dollar) ,' ., _,Z;771' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? .'Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes iff-No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? CI Yes al No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes a 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 '3 Don't know <br /> 7. Is this to correct a violation? ®Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aioa) (Continue on Back) -► <br />