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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> C i L C-g�v-ec-S 'n oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> E(-'0`i S1'#?),Ab-ciEU , C_055 -y(_A)A5 u.I.- 5-35z6 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 7 ca -Z 19 Cd 576-- e0-3 Z '_.c (7-16 c C (---\1\a c' ` ' A Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> GRE_ S IN CO(\S;V-LkC31c,1 TV\C-- Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3c,c)k-.ti 5p2IA€Fl CL.) ' 7 - <br /> (city,State,Zip) (City,State,Zip) 0 etbacks <br /> C 55 1-7LAirlS t,:, `73SZe <br /> PHONE PHONE LI Site Plan approval from <br /> 7 1 7 - 3c \\ applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r c3CJ x'70; 6, cci—c,c k)\-- 5 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ evation of property <br /> PARCEL . L/ frontage drawn to scale. <br /> NUMBER — 70(3C_)‘:16/DV-S' O 33 46 S .s„ g <br /> TOWNSHIP: SECTION: <br /> lye \7Dtr�'rc/\ ❑ Driveway permits- 1- /4e /1/ <br /> ADDRESS: <br /> (state,county,town) <br /> ■ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Qbt (public,private) <br /> S ck o S C i g i <br /> PROPOSED PROJECT INFORMATION ' � <br /> PROJECT DESCRIPTION: <br /> . *This project is a new building or structure. <br /> LI This project is an addition/alteration to an existing building or structure. _ . <br /> - <br /> SANITARY SERVICE: PERMIT NUMBER: : '° -.1^-,',1'.1 <br /> ❑SEWER r]�SEPTIC 'I , ' <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: '® ,-K <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) °" <br /> 0 IL a i <br /> BASEMENT: `� 1ST FLOOR:2._c <br /> 3j sU YES 4, TOTAL SQUARE FOOTAGE: 4, ad w v <br /> 2ND FLOOR: 3RD FLOOR: <br /> kh',,,P*Iit,Kaliti,i',;:iVit.M <br /> ESTIMATED CONSTRUCTION COST: _ r e , <br /> (Please round to nearest dollar) --0 —0 —0 $ "2'�'(7/7�C) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes XNo ❑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? ❑Yes '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 4 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ,No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* —0. —► <br /> 545-112(4/08) <br />