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-305C- 'H ,r( <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW ER NAME p 4 n <br /> ('3 LI ^� AT Tit ��, 111 t I PZ- I ❑Zoning atu , CUP; <br /> OW ER ADDRESS (Number,Street,City,State,Zip) Deed Res tion; CSM <br /> -2 8 L4 KS`T�7�1 �-( • (' ' l�Ot ETot�},1�L <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADIIRESS <br /> �t�g-6��iD _ yVt1Y�3r'1 •url�✓►e''�rGs'4f��tyc ❑Site Plan Ora to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> LQ G A N c1-1 A M ER ❑Site la ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w I tic <br /> 6 S 5 soNSr—r MEb. MAA--7 <br /> (City,State,Zip) (CV,State,Zip) ❑Set Cks <br /> W 1N3=25.cg , La/ 5 35-gg <br /> PHONE r n PHONE D <br /> a l5 45 2 608-5-(S - 45 g2_ applicdth t.'1. iP <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plascale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevati of operty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER O�O 0(I 9'(4 v7d ( frontage awn to scale. <br /> TOWNSHIP: SEC LION: <br /> • <br /> '/a: '/a'/a: ❑ DrivewaX its <br /> ADDRESS: (State, n) <br /> CSM: LOT SUBDIVISION BLOCK/LOT CI Sani I iv p m is <br /> (pu e) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PR. T• - -TION: <br /> .‘ 0 ill ' i ,V At it.. 4111 A ■ ❑ Zonin D' trict <br /> . his project is a new buildin• or structure I ❑ Per <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: /�,r, PERMIT NUMBER: ❑ Rural Address <br /> EWER /IJ�BEPTIC (new/e ) ) <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetl. 0 F000dplain/ <br /> `� Sho f :+ d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Al(::, <br /> ❑ (sIo f trol permit <br /> `'//� l TOTAL SQUARE FOOTAGE: 4, (SIo S .ance, <br /> filli g/ ;•ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> t9Q' ❑ Revi a '•n Survey <br /> ESTIMATED CONSTRUCTION COST: -► ♦ and tom'a.1° options. <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 ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Elves ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes ❑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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> A r •P APPLICATION MUST BE SIGNED <br /> 545-112(aioe) <br /> \1\+ (Continue on Back) ■ - <br /> a\'/ <br />