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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME <br /> Do us S [`•`'iLi ti Z94 g Status; CUP; <br /> OWNER ADDRESS (Nu ber,Street,City,St e,Zip) \\ J � De d Restriction; CSM <br /> 3 0 (o S ho rk-U t..c,� �`�� 5�v u�hi-pk, VI.JT V riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS J <br /> 66, -23S--- 7 C) do S &ksy.„G,,,,s-L <br /> v /d✓V.c' <br /> tj4ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION <br /> includes dimensions <br /> AGENT NAME CONTRACTOR NAME -} <br /> '1 ) 441— CIIZA/" �L,t,L ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS (Ofwell/setic <br /> CD-1 Lt bQr 1-) 1 .f v Ue. <br /> (City,State,Zip) (City,State,Zip) WA Setbacks <br /> U,2.rotNA Lk.)t c-35" <br /> PHONE PHONE 3 jPlibshiP. <br /> e Plana val from <br /> (qbc _ -CiS,-r 2Z`1O <br /> E-MAIL ADDRESS E-MAIL ADDRESS or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: Elevation of property <br /> 1=1 PARCEL 0 /6)0o 2_O2V'-7 \ ' /33 frontage drawn to le. <br /> NUMBER <br /> TOWNSHIP: SECT <br /> `J—vw,✓ C1= I JOA/4/ O 1/4: 4/0 1/41/4: Nk) ❑Driveway rmi <br /> ADDRESS: (state OUn own) <br /> 2-,0`1‘1 '3AKb-tlZ Drv've., ❑Sanit.• permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p r IC, private) <br /> LI'v ,v Ad-IL , <br /> PROPOSED PROJECT INFORMATION $ FF REVIEW <br /> PROJECT DESCRIPTION: <br /> -SF ❑ on g District <br /> This project is a new building or structure. ❑ rmitted - _e? <br /> his project is an addition/alteration to an existing building o tructur . <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R ral '. ••re,' <br /> �EWER [EPTIC V) 1 L ( ew -xisti • <br /> HEIGHT IN FEET: 1 NUMBER OF STORIES: (Not including basement) <br /> 3) 7 t 2 dpiain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> S oreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: Jr IonControl permit <br /> I Z C( 1 18 1 7 4, TOTAL SQUARE FOOTAGE: + (SI pes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: V fl) ng�access) <br /> 1 tg 11 c063 eview Location Survey (- <br /> ESTIMATED CONSTRUCTION COST: and available options. •--� <br /> (Please round to nearest dollar) ♦ ♦ ♦ -9. ♦ '♦ $ 9 S-p p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? s ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es ❑No DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [INo <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes VI]No <br /> APPLICATION(Continue Back) - SIGNED <br /> sastt2 ta/oa� <br /> (Continue on Back) —► ♦ —►_____.1 (7 c _ 7.a, <br />