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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �I <br /> /Yl4 /ry rK Fs /T et vl, 0;1 Zoning Status;CUP; ;f I— <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Re rictipn;CSM <br /> II 0 7`gel No/k. £s,- V koHC. GU 3S"r 3 V •. ce(# — 2-3-2) <br /> HOME PHONE CELL PHONE E-MAIL:DDRESS <br /> 6d'f yv,s--73W3 4Qk 23S=7SS/ Al Site Plan drawn to scale II �r� <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions V <br /> AGENT NAME CONTRACTOR NAME <br /> /)/ by E.s7ewjy ! Site Pla uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of we 1'.septic I f/ <br /> (City,State,Zip) (City,State,Zip) �)1 L <br /> ( ty, p) ti Setbacks let 2. 3x ' <br /> PHONE PHONE X.Site Plan appro al from <br /> applicable tcvvrt�f <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> y��//cale if <br /> 4 Floor plans to scale / Z <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) :) Elevation of property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: q P P rty <br /> ❑ NUM ER 060 8 093 Q Liek -- / 0, cf / fr9�`(i'%aae drawn cale. <br /> TOWNSHIP: SEC , / ���v o 2- 4 <br /> v' t O9 1/4: S 1/41/4:S 14 hi Driveway/permi <br /> (state,county, <br /> ADDRESS: <br /> w <br /> 07 V 2 //bt�a A- • XSanitary•. ••its d 4 <br /> CSM: ��� LOT SUBDIVISION BLOCK/LOr (publi• priva ) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> in Pmt » .,r <br /> �S'T6r4;.e 4/e }, e. It <br /> - - Z 4 .. �. I 3 <br /> This project is a new building or structure. ® ,rr <br /> Cl This project is an addition/alteration to an existing building or structure. ; .t' ' 7 <br /> SANITARY SERVICE: PERMIT NUMBER: `c i$ �� p , <br /> ❑SEWER SEPTIC : Pa Og ' <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement) - 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: ,!. ® r A `- <br /> Al 6ii 2' ' ci 4, TOTAL SQUARE FOOTAGE: �i ' l if� X <br /> 2ND FLOOR: 3RD FLOOR: #" ,,,;,„ _,.. , ,,..y..--1„-...,,,, h <br /> Iv i lc efa 05'Yo ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ u ," .sty <br /> (Please round to nearest dollar) $ 1 00 V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ii4No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes No <br /> No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes .[If 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 allo ❑Don't know <br /> 7. Is this to correct a violation? DYes a No <br /> . <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —* —► <br /> 545-112(4/08) <br />