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1 ,3a .0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 0—nr +h i e St b ul D‘ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1D.70 T4 1 II S t Aa_ -12..c\ Variance(# 0579 ,) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6t* zO /Z/ /< % L-SS-tf) 6/4411/1- ' CDC ❑ if landrawntoscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE i e PIan approval from <br /> applicable township. /t/(,.. - <br /> E-MAILADDRESS E-MAILADDRESS <br /> o - aans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: evatlon of property <br /> ❑PARCEL p ,V2 n L k frontage drawn to scale. <br /> NUMBER 05la—l I)--5730-0_ - d 5 . 3 10 <br /> TOWNSHIP: SECTION: 1 � � <br /> '/4: N E '/%: .N W riveway permits <br /> ��� t�h \ (state, county,town <br /> ADDRESS: <br /> /2 70 /-7//LL Si PL^ Boil D Hilary pe •s <br /> 4 <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 3 1 (public, •rivate) Ats- <br /> PROPOSED PROJECT INFORMATION .S FF REVIEW- <br /> PROJECT DESCRIPTION: <br /> mac -)sr-e r sin rc 4\2 A Lio i X co 3 / ( Cting F ' gnct <br /> This project is a new building or structure. �rmitfedUse?' <br /> This project is an addition/alteration to an existing building or structure. <br /> ❑ P 1 9 9 <br /> SANITARY SERVICE: PERMIT NUMBER: Adress <br /> [EWER 1EPTIC (newt= <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) t,ve'''''*- <br /> t(atClCtpl (nt Silt <br /> c <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: 0. 0 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> osibneenttol permit . <br /> 5 Q ,, TOTAL SQUARE FOOTAGE: + (slopes,+ isturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> T <br /> a5 �O <br /> ESTIMATED CONSTRUCTION COST: + eyy,WcattUft-Sucve f <br /> (Please round to nearest dollar) -► �/ CCU � . " -'eifpf0tQrtS -, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? TEYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes NINo EJDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ENO <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? in es QNo <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 Jlo ❑Don't know <br /> 7. Is this to correct a violation? Dyes 5kclo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -i <br /> 545-112(4/08( <br />