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q <br /> L l/te7 n�i W ,(1L/� 1'J wS ,9ewt it f� 6 1, <br /> S <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TOP OVIDE <br /> OWNER NAME /• <br /> t)/GGu J P-7/ , i)U,J -LAS A- 3q ) , 7€ ❑Zonin s; <br /> CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed triction;CSM <br /> ?/9/ oL O // /20 DAVE 4.'1' E 3 c? Variance(# ) , <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> .o8 $y4 , : ,�' i(c Da-0e , n3 <br /> N -�. i-T tvrc';� AHoO.CO�'t ❑Site PI n drawn scal- <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes • ensions <br /> AGENT NAME CONTRACTOR NAME <br /> SQVY1.r? Ft(ati Cu -am )ilders ❑Site Pla i uding location <br /> AGENT ADDR S CONTRACTOR ADDRE of well/se tic <br /> 1553 1 I}" trt u-G <br /> (City,State,Zip (C' te,Zip) ❑Setb _ ' <br /> L <br /> li AAdsht,�, W I S��i ca . <br /> PHONE PHONE ❑Site Plan approval from <br /> ��- 33)—-1 8 g applicable township. <br /> E-MAIL A E-MAIL ADDRESS i ill <br /> mu._o ( CaalOWOr r Floor plan t cale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of r0 Ity <br /> PARENT PARCE NUMBER: CURRENT ZON G: ACREAGE: <br /> ❑PARCEL a. a 0 q(g_o9//1.002- / A-ICE ) 35,rf I c frontage dra to scale. <br /> NUMBER <br /> TOWNSHIP; SECTION: ' y 1/J R' <br /> Dot V.. Ai ��: Al /aA: Drive,c pe Its <br /> ADDRESS: (state, u ,town) <br /> told 1-I 13 •J • • • ' : ^ v <br /> LOT SUBDNISIO BLOCK/LOT ❑S- 1: At •- 1 <br /> (p • "p:. )7l( <br /> PROPOSED PROJECT INFORMATION STAFF REIJJEW <br /> PROJECT DESCRIPTION: 1 1_ Co 1I/ <br /> NQ.� HD — Cc)f ,clop y1 ❑ Zoning D ct <br /> . ' This project is a new building or structure. ❑ Permitt se? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad. - <br /> m•EWER ri.EPTIC <br /> - _ �� (new/, 'sting)Ill <br /> HEIGHT IN FEE r I 15 NUMB STORIES: (Not including basement) <br /> C ❑ Wetla Fl • <br /> Sho an ( ent) <br /> A EA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit__ <br /> -*0-r� l 5q. Q ' r7 +, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, . <br /> �"I 1 `� O�`1 !g filling/access) <br /> 2ND FLOOR:' 3RD FLOOR: .1 /i 0 q y <br /> !" , �6 q 4-07 ❑ Review -• '•n Survey <br /> 6 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -* -1, -► -*► $ of ,Ow ( and av . - •• ons. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Jlo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Vo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es 'lo <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 in o ❑Don't know <br /> • <br /> 4w 7. Is this to correct a violation? ❑Yes Z <br /> \ 4•11■_ <br /> �,nn CL9 L2 V�,0 6 •' zl- cen6"6"" vtd) APPLICATI N MUST BE SIGNED <br /> `�V " ` \ (Continue on Back) ♦ ♦ -, <br /> 545-112 0-s, r(.c�Q �' l�' " ""z - <br /> pi,cv K ,,�9 C vg�_S2_ ,c <br />