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Ass <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION ;tr. - '° <br /> CUSTOMER TO PROVIDE <br /> OWN NAME /� / / <br /> Tholy Thomas As 4- /� uTil N. A['e150 Li ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 2 V 6 r1 �A es%le S rdr2e-e —/t1ail'c0h 6'3T21! Variance(# SS-VI ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3 3 5-l 6 r7 <br /> OlMn2 ^ H i/'"./ - 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) LI Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http a/accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRE ONING: ACREAGE: P p rty <br /> LI PARCEL / ` frontage drawn to scale. <br /> NUMBER PJ6'�O—Q��^ l�S�O( � • l � g <br /> TgWNSHIP: SECTION: <br /> awn ' 6N J.0. F ,: o 1/41/: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2Y6'7 tal4es /We 57 <br /> ❑ Sanitary permits <br /> CSM: LOT S BIIVISI N BLOCK/LOT <br /> IS (public,private) <br /> I'd o • <br /> PROPOSED PROJECT INFORMATION :7t. R <br /> PROJ -2E CRIPTI N: ' <br /> ❑T)Is project is a new building or structure. . .. <br /> 'Z f S1 � flfl_f3 ,o,. 9 <br /> This project is an addition/alteration to an existing building or structure. A <br /> SANITARY SERVI�C PERMIT NUMBER: $3.�, -p��19"�9�°�(C.���," <,`...� <br /> L'J SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> X I -1 �', a5 eit: a°c.tt'tea{z 3/ F. <br /> � 5 - fl[ fl <br /> AREA TO NEAREST SQUARE FOOT: 4 _ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �, 3 <br /> BASEMENT: 1ST FLOOR: ° ° r � <br /> 3 7 z, TOTAL SQUARE FOOTAGE: 4, „ ' ° i - <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3 77 ,, � <br /> a`r'c-,, i ,,.�, " °1 -° 6� g'�g� �-, <br /> ESTIMATED CONSTRUCTION COST: D ��� �, g a:'-° <br /> (Please round to nearest dollar) ♦ ♦ "♦ "� ) (J� 'l <br /> ¢J ,��"/_ � �e."� x <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LIYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes Cairn ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Lo's'es �L7❑,NNoo <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# '35a-7 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 0 N ❑D •n't know <br /> 7. Is this to correct a violation? ❑Yes 1lo <br /> APPLICAST BE S...0.1 D <br /> 545-112(4/08) <br /> (Continue on TION BacMUk) —► GNE—► <br />