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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME <br /> G- s\-\e_ Own J s<) 0. ' Zoning Status;CUP; <br /> OWNER ADDRESS (Number,St eet,City,Stat, p) Deed Restriction;CSM <br /> `-(55 `1 S rp e/A �f i J� U��GY1)W \ . 536 V1/4'5 ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AISDRESS <br /> (AV '235 '55 `1, CC( of k (it.„,-\e", . C YC Si Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENTAIAME \:) CONTRACTOR NAME <br /> IN n 0C e..(Z RI ud b e �S C„-•\,\c'\ Site Plan including location <br /> AGENT ADDRES CONTRA,ORADDRESS V <br /> of well/septic <br /> h(0'7 a �v\ r n c c% t,\b .( <br /> D:. \'\arc - <br /> (City,State,Zip) (\ \ �:‘ . 5 7 (Civnty,,tnSttate, ) Setbacks <br /> PHONE PHONE ❑ Si - •'I-• -pproval from <br /> to 8 ' g 36 • -1-1 fit. (0 0% . .•• 'cable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> . ,h , G\ Pad • ,, , ; ' —� • l'■or plans to scale <br /> PROPE•:TYLOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENTZ NING: ACREAGE: <br /> LI -levation of property <br /> PARCEL O rJf©,...301 �,5/R� 1 (� N� 3�'J� /. Q frontage drawn to scale. <br /> NUMBER `�JI V c( R <br /> TOWNSHIP: SE TIO : {{{ r n 1 '_ ` ❑• V1/4: 1�� 1/41/: N 1•t/ - ' <br /> ADDRESS: ate,co - ,town) <br /> WI e 1 ❑ S- itary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT public,private) <br /> PROPOSED PROJECT INFORMATION <br /> F777: <br /> PROD T DESCRIPTION: r <br /> ovCvn. �qAC (t�... CQ A- cr" )A 2OYC� W■ •∎ �> � s - s <br /> ■ <br /> . ❑This project is a new building or structure. Mt. � <br /> This project is an addition/alteration to an existing building or structure. = � <br /> SANITARY SERVICE: PERMIT NUMBER: E B t�- k at ' r <br /> ❑SEWER FA EPTIC ��,. �- : <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not including basement) ! ;.',4;.- - ,'- ' <br /> AREA TO NEAREST SQUARE FOOT: -' * ):N.: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) g f <br /> BASEMENT: 1ST FLOOR: $ <br /> 4, TOTAL SQUARE FOOTAGE: 4, s' 43 � .; <br /> 2ND FLOOR: 3RD FLOOR: ` s ® , - " <br /> ESTIMATED CONSTRUCTION COST: r`_ <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 IiiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes til No ❑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 51No <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 IANo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes .(No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> 545-112(4/08) <br />