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ZONING PERMIT APPLICATION <br /> www.countyofdane.com <br /> SUPPLEMENT to Web- <br /> " 0:,,,1144y .: ,',!!_App # <br /> PROPERTY OWNER INFORMATION OFFICE <br /> OWNER NAME <br /> t� <br /> OWNER iliSS (N�umbe"r,Street,City,State,Zip) + Q�tng l fSt1Cf _ ;each 60 <br /> � 5� /'i rrf C S/ l,�i z Cre cj ' � �-✓i �5.3� j Permitted Use?. <br /> PHONE E-MAIL ADDRESS <br /> ?� — 9g-, Zoning tus;cuP, <br /> AGENT INFORMATION CONTRACTOR INFORMATION Dee # estnCtion CSM <br /> AGENT NAME CONTRACTOR NAME Variance.(# a <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Site Plan,drawn to Scale <br /> City,State,zip/ �s�N`���� �� ` iand ncluc e; dimensions <br /> ( ty Zip) (City,State,Zip) <br /> P ONI � ��-� I-7'/ • PHONE L Site P �I :c1;:3,C, 'location <br /> ,57-76 <br /> — Q� �.r ri ' ,S tIGe a <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> K �*v <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 'L Site Pia approval from <br /> PARENT PARCEL NrU�MBER: ? ( / ZONING: ACREAGE: l <br /> ❑ PARCEL 1 c /V `��J �1��IA�^ I�lC4a etQ1�Yn5Ill{� `: <br /> NUMBER v W I Q1,} <br /> TOWNSHIP: SECTION: 4, <br /> Urly /a: � Rra�tltess <br /> ADDRESS: /a�/a: ( ew/existiing) <br /> S� x <br /> CSM: LOT SUBDIVISION BLOCK/LOT _ " F(otar plans to Sole zx <br /> PROPOSED PROJECT INFORMATION atlQri of n to sc <br /> PROJECT DESCRIPTION: m tage drawn tb Stele" <br /> � � �lid�Jl� '❑ Driveway permits <br /> ❑This project is a new building or structure. (state,,county,town) m <br /> Li This project is an addition/alteration to an existing building or structure. ' <br /> ❑=Santtaermtts <br /> SANITARY SERVICE - PERMIT NUMBER: <br /> (public,private) <br /> SEWER ❑SEPTIC "1-' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) Wetland/ loodplaln <br /> • Shareland attachment <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> �rosion�vtitrQl pem�ut� <br /> BASEMENT: 1ST FLOOR: (slopes,disturbance, <br /> Z� l TOTAL SQUARE FOOTAGE: j <br /> 2ND FLOOR: / 3RD FLOOR: _ it(irlglass) <br /> Zo <br /> / . Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and a vailable options. <br /> (Please round to nearest dollar) . 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? <br /> Li yes <br /> I�No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes ©I�lo ❑Don't know <br /> 3. Have you talked with the township about your project? 0 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0 No <br /> 5. This project is associated with arezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes o ❑Don't know <br /> 7. Is this correcting a violation? Yes �J No <br /> o <br /> �� cAPPLICATION MUST BE SIGNED <br /> J VVV (Continue on Back) =► -► -0. <br /> 545-112(iroa) <br /> Z'1s ( <br />