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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION <br /> OFFICE-USE.QNLY <br /> OWNER NA qq // S,,�' .� a <br /> OWNER ADDRESS (Number,Street,City,State,Zip) QfIIR� ©ISf�IGt `� <br /> 1l S �y /&vl ,B/NF me u�ils ' '/ 3S'7 � �' <br /> PHONE E-MAILADDRESS fi�erniltted'�Se? .: <br /> 1 Zoning Status,CUP <br /> AGENT INFORMATION CONTRACTOR INFORMATION ®eed Restriction CSM <br /> AGENT NAME CONTRACTOR-NNAMEQ e Variance( _T <br /> AGENT ADDRESS CONTRACTOR ADDRESS c� Plan drawn t scale <br /> `rf `"J nd;iricluc es-tlimenslons <br /> (City,State,Zip) (City,State,Zip) ' <br /> tit:it,,: -- i.�-- . g I©Cail()n' <br /> PHONE PHONE _ t; <br /> lOa7' 3`f-1 �3 sZ 0 . se• CCU: m ,i<, <br /> E-MAIL ADDRESS E-MAIL ADDRESS , bac <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.us/) Site.Pla t pFflV f fro n, <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: - t 0 <br /> ❑ PARCEL *L ero6 -o pY.- <br /> 6230 o a a- A: $ l cabl towns p ;# <br /> NUMBER � 4 16 :401 4 - �, <br /> TOWNSHIP: SECTION: ' , 1 �. sdtc sf £. 4 <br /> rezvK ni rzen.a.JiE �a: SE /� �a�: S6 /j , <br /> J*oe e?415.[ng ` <br /> ADDRESS: Q } <br /> ����� 5 �C.1' # •, ,' }� 111 <br /> 1 lo4.r�plans to seal • � / <br /> CSM: LOT SUBDIVISION BLOCK/LOT x k <br /> 12e'12 / p- m <br /> PROPOSED PROJECT INFORMATION <br /> IriVa drawn to kale <br /> PROJECT DESCRIPTION: � � /10„..‘„c„..24, x atip <br /> � lJt1v vay Ike Y rl t <br /> staff <br /> his project is a new building or structure. �*tn <br /> ❑This project is an addition/alteration to an existi . - • .r �Y 5'- <br /> t ; � � <br /> SANITARY SERVICE: <br /> IT NUMBER: $.1.:00:1;:01t744. :;:'` <br /> ❑SEWER SEPTIC 6 / / / - £ ,, <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not includin. . - ment) : W e: x ..y a� I � S� otl•r° � �►~ <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , <br /> BASEM NT: S n 1ST FLOOR:3 b „ 0510O, O("pe►'fTtll <br /> /� 77 23 j TOTALSQUARE FOOTA E: ,, peA istla�b 1Lre,: �' ' <br /> fp`Z / £ fil(Ing/acc ass) <br /> 2ND FLOOR: ✓ 3RD FLOOR: , <br /> ESTIMATED CONSTRUCTION COST: n 40810.56$51%%013-F <br /> Please round to nearest dollar ♦ ♦ ♦ '� $ 2 e)v " p �d atla bl ons <br /> ( ) �_ r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes l o ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes -E�JNo ❑Don't know <br /> 3. Have you talked with the township about your project? ..2'Yes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes allo <br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes .ENO ❑Don't know <br /> 7. Is this correcting a violation? DYes ,8'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ --► --►' <br /> 545412(1ro9) <br />