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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,�1 Mel/ <br /> Date. d ,JI'GA -'e ` ` f Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> G 8'6'9 Lac. fA,a RD( Ooze Variance(# i l l 35 ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS r a r)9--56 Os S.' , e d s• / ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE NJ NAME CONTRACTOR NAME <br /> J -C t'',t..G 6 ' 1(<.r Gill-es co, COGS t e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> l 90 5 izvo o <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> Guavas, k-e -e ft, <br /> PHONE PHONE Ite Plan approval from ,( /4 <br /> 406(-.2g0 —9 8' 0/ applicable township. 1� <br /> E-MAILADDRESS -MAIL ADDRESS <br /> doh t 1 "Tar•Al e r —� loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑NUMBER clog-•�73-c -0 g� — I '� . a 6 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 0 and 'a '7 1/<: Ste..) 1/s%: S lil riveway permits <br /> ADDRESS: (stat county,town) <br /> mob A <br /> Q 1�) L.OJ�‘^- ' JBD Sanitary permits <br /> CSM: LOT S BDIVISION BLOCK/LOT <br /> I I (public,private) <br /> PROPOSED PROJECT INFORMATION APP REVIEW <br /> PROJECT DESCRIPTION: <br /> S F w/ S cimtava arcin g District <br /> . its project is a new building or structure. ! Permitted`Use? <br /> ❑This project is an addition/alteration to an existing building or structure. [� <br /> SANITARY SERVICE: PERMIT NUMBER t-J Address - <br /> 3 ( ) _ xisting) <br /> HEIGHT IN FEET: EWER Der-IC NUMBER F STORIE (Not inEluding basnt <br /> i i$ i 6 " "Loth etlandiPbodplainJ <br /> Shorelarid (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ncontrol permit <br /> BASEMENT: 1ST FLOOR: p , AJO <br /> 1 TOTAL SQUARE FOOTAGE: ii(slo 1es, tistu n e, <br /> t O$ 3 3 c 5 titing/a ess} ,n. <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1-'I CO / eView Location"Survey <br /> ESTIMATED CONSTRUCTION COST: -* -0 -0 -0 -0 $ d Sya Je-0 . ; �_ <br /> (Please round to nearest dollar) 8�y 00 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes J]No $;,;'won't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑1'es 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# ) e blank if none) <br /> 6. Is a location survey required? (see reverse) ►4M =. ❑No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />