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17/6"----..., <br /> • ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �1, <br /> �ct► w\LI Ar'S3 R,A -EPPl.EiZ - •R Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> 43045 1+A.tL L-t . S-soUG-L-i TO+\ u.) I S 3584 Variance(# _) <br /> HOME PHONE CELL PHONE E-MAIL A3DRESS <br /> 1 -(o 1 al- - $9 KM Z u ' TOS -1,) -T w!_r Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> LkINStc L- M.ECGI.E S 1-4rc e7J1uoE2S Gif.ADOP I Of, . Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS l of well/septic <br /> l' ?% 5 • o W ,■ oft, tad S. OUJE.,\) bk_ . <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> _4 A O ISot \,._1 S3lO5 MAOtSorA 1 WI 53105 ` <br /> PHONE 1 PHONE r% 'ite Plan approval from <br /> a04-001,1 aoq_oo-i 4 a,plicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usf) ' levation of property <br /> 1!►. <br /> PARENT PARCEL NUMBER: �y CURREN ZONING: ACR AGE: P P Y <br /> ri PARCEL CAS/c —414'9`I S,Q RI ) ..-S.3S rontage drawn to scale. <br /> NUMBER 1 I <br /> TOWNSHIP: SECTION: <br /> 0-11.--I n a1 1/4: E 1/41/4: ,P-7 Driveway permits <br /> ADDRESS: <br /> state,county,town) <br /> 4 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOC oT •ublic,private) <br /> iU5-3c) a <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ' ' <br /> } vrJ St NS _ FNMA- 'RANG 1.( L . a ,: <br /> . ,4 This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. , _' <br /> SANITARY SERVICE: PERMIT NUMBER: i 7 <br /> • <br /> ❑SEWER SEPTIC '1 VZ e ., ° ~; <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 4 <br /> r-ee <br /> I ® .gy . <br /> AREA TO NEAREST SQUARE FOOT: -W <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Z;,., <br /> BASEMENT: 1ST FLOOR: -e . , ° <br /> alb?, 3354 4., C 3- 3L g(\ ,, TOTAL SQUARE FOOTAGE: ,l, . a <br /> 2ND FLOOR: 3RD FLOOR: ;.„ " <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) = . .� <br /> ( ) -� ' -� .9 9' -► $ : � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 121,No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes la No LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Igi Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 4 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 /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> 545-112(4/08) <br />