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ZONING'PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER �M�E�� <br /> ��� H Ply bM 1C2_. <br /> !Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) //�� Deed Restriction;CSM <br /> 16'i3 57-042 y7 v K..i b Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ,�� <br /> 4708'8.35-0087 it 2-61 l Jock @ PL./44-0^1, csM LEI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ak a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS �, of well/septic <br /> I�H <br /> (City,State,Zip) (City,State,Zip) 5etb.cks <br /> PHONE PHONE 2 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS �, <br /> Giroor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) UJ-Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: operty <br /> ❑ NUMBER 0509-05 2-gy40- rj Q6S 1, 07 7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 0Z • �rivewaypermits <br /> b60 D a%) '/`: 1/1/: <br /> (state,court ) <br /> ADDRESS: ( ty,town <br /> (‘'q 3 s7 7o,.,,./ Q � <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1 0(1 I (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: � Ti,w <br /> P6O0L. — `tO'x2o` lNC„Qoan+fl b� _- <br /> Et This project is a new building or structure. � 4!. <br /> ❑This project is an addition/alteration to an existing building or structure. ,° <br /> SANITARY SERVICE: �t , e air: K <br /> PERMIT NUMBER: — h „--,,,-.'4,"--1 <br /> ❑SEWER ❑SEPTIC < It a ...--4,,, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) f <br /> �� 1 &i 74s <br /> AREA TO NEAREST SQUARE FOOT: rt. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: - Ita l� r t. <br /> ,, TOTAL SQUARE FOOTAGE: 4, ,` wki + E W <br /> 2ND FLOOR: 3RD FLOOR: ` ) 4 . 1 <br /> a - <br /> .r,,, -IMMO ifit,;: ::ii ; 74.ZiL:"4-1'1:14N:1 <br /> ESTIMATED CONSTRUCTION COST: <br /> round to nearest dollar) • .+ -∎ "0. $/S, 0 O 0 ' ` ` ', <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes tgNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes arNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ®No <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 ❑No 0 Don't know <br /> 7. Is this to correct a violation? ❑Yes l No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -► -O. <br />