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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER NAME <br /> A\4 ' &1AZT"! . • o ing Status;CUP; <br /> OWNER ADDRESS (Nu ,S'reet,City,State.Zjg� 1 D d Restriction;CSM <br /> 7►� ✓�}//� " „�.- 1 V riance(# ) <br /> HOME PHO< E CELL PHONE ,/ -MAIL ADDRESS .� <br /> tee, ' 4Cri �� ❑Si e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATIO'.J a includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C ' E7e ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1'2/0 CL-liettze- ,417 <br /> (City State,Zip) �� `Vt•537' (City.State,Zip) Setbacks <br /> AV,A71. 4-3, ❑ <br /> PHONE , PHONE t Plan royal from <br /> �7•47440. lira township. <br /> E-MAI AL DDRESS E-MAIL ADDRESS <br /> ep ogi 44.41...,CBS oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (hltp://accessdane.co.dane.wi.us/) Elevation of propert <br /> PARENT PARCEL NUMBER: CURRENT ZONING • ► I ACREAGE: p ro p <br /> El PARCEL �3 $06.1•t33o-o rti' 5 • rjoe frontage drawn scale. <br /> r r.v H- '/.d a y !4 SECTION. : . 3575/4 Fi0E ❑ <br /> Drivewa ermits <br /> ADDRESS ,,� 1 I' � (state ounty,tow ) <br /> M a3 h i �1 Z ��J� g fl�JSZ/ Sanitary permits <br /> N't Q,___ <br /> CSM: LOT SUBDIVISION BLOCKILOT ❑ y p <br /> ogt et C9 evx DI--Z� •ublic, private) <br /> PROPOSED PROJECT INFORMATION %TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 12.0∎30VA"'l6i•-) ei)r Te,__ g. i4 AL.17s7,4--rio.%4 ! •ning District <br /> . ['This project is a new building or structure. / ! ❑ Permitted e? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE. PERMIT NUMBER � ❑ Rural 'ddres- <br /> EWER ,EPTIC / 3 — eo/ ( 6:0 (new/- - <br /> HEIGHT IN FEET: NUMBER OF ST RIES: (Not including basement) <br /> / ❑ Wetian loodplain/ <br /> Sho and (attachm-, <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR:..43,c1.0.7-5-* A�� ❑ ECOSIOnCon permit <br /> I TOTAL SQUARE FOOTAGE: I (slopes, •' tur ante, <br /> —vv fiill • :cress) <br /> 2ND FLOOR 3RD FLOOR 40, IIE J ❑ Review Location Sury <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) $a 00 © o <br /> l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ANo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ElYes N o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ges /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) Des NNo ❑Don't know <br /> 7. Is this to correct a violation? flYes 4No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) _ _ _ <br /> 545-112(4108) <br />