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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> QC Li,,'I^b ) c v5 ❑Zoning Statu ,CUP; <br /> OWNER ADDRESS (N ber,Street, ity,State,Zip) <br /> �R A a �u I; R f r i(5.- (" S 3;3 Ci Dee Re Iction; CSM <br /> Varia a(# ) <br /> HOME PHONE CELL PHONE ..., _,.? E-MAIL ADDRESS <br /> 6 UR )1 6 )7 ❑Site Plan ciraw.7to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includkidimension s <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan ntitictifig location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se <br /> (City,State,Zip) (City,State,Zip) ❑Setbs <br /> PHONE PHONE El Site P n ip oval from <br /> appli a hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor pla to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevate of roperty <br /> PARENT PARCEL NUMBER: 32) 1 _ CURRENTZONING: ACREAGE: <br /> ❑PARCEL --- Ell frontage wn to scale. <br /> NUMBER Sv(C)—�) <br /> TOWNSHIP:' SECTION: <br /> )c) G1€._ 1 1 1 ❑Drive its <br /> /4: /4/4: <br /> ADDRESS: (stat , c unt ,town) <br /> 6`86 �ve{ i 1\ Rd '' carb2 wr C)3d °1 <br /> cSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,priv <br /> PROPOSED PROJECT INFORMATION "STAFF -E ItEYV <br /> PROJECT DESCRIPTION: � <br /> 6U (/(/1 r G f 0 ZOt111'1 f1C <br /> zr uY " 7:f <br /> . ❑This project is a new building or structure. c Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ' °' ess <br /> EWER OEPTIC <br /> HEIGHT IN FEET: /� / NUMBER OF STORIES: (Not including basement) <br /> r y t (.�/�/ E'� Y . "attachmennt) a a(�� <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) _ <br /> BASEMENT: 1ST FLOOR: i : p�Crn� <br /> TOTAL SQUARE FOOTAGE: •• °i (7 e� �, <br /> 2ND FLOOR: 3RD FLOOR: �� 50 � � <br /> ESTIMATED CONSTRUCTION COST: $ C •rtunfey' <br /> Please round to nearest dollar) "� "� "� -0 �J CJ� OD d an =. op ons. <br /> ( <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? esNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es �No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? —VISA ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? UYes ®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 p.„'-4( o ❑Don't know <br /> 7. Is this to correct a violation? Eves ghp <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -0 <br /> 545-112(4/08) <br />