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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION ' FFICE USE ONLY <br /> OWNER NAME <br /> L in u s Al 'et ' s oning District <br /> OWNER AD SS (Number,Street,City,State,Zip) / , L ? <br /> 70�'.cs c, mn c/e- /V e1' L�vau,,a tee 5 '59 7 ermined Use? <br /> PHONE o E-MAIL ADDRESS <br /> 6o:) ( 1`- — 3 rs/ zoning Status;CUP; <br /> AGENT INFORMATION I CONTRACTOR INFORMATION D Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME dance(# ) <br /> 11 r <br /> ir gir.,- 6-7 <br /> 0-4 5-7!'eeC rierA <br /> AGENT ADDRESS CONTRACTOR ADDRSS ®� e Plan drawn to scale <br /> w// S6 7 4 d �t nd includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> L c e/ Gc•'l 3-35-55- S'a Plan including location <br /> PHONE PHONE weluseptic <br /> `L g, �--12 - 7v/2 <br /> E-MAILADDRESS E-MAIL ADDRESS /backs <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT PARCEL NU ER: ZONING: ^ ACREAGE <br /> ❑ PARCEL 0 /�1 • P - QO©d„ Y / E K .31‘ 5 applicable township. <br /> NUMBER v �•C <br /> TOWNSHIP: , SECTION ❑ I �� <br /> t Q n (Z Q __,2/.,-.? 04: N' ) ) yoh: S‘e,) new/:xisting <br /> ADDRESS: ,� I_ <br /> J �` V C oor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Elevation of property <br /> PROPOSED PROJECT (INFORMATION /� �/ frontage drawn to scale. <br /> PROJECT ArO 71/1/14 __, J P4vsh y eo a`01 V / /� da ❑ Drive t "� <br /> . ❑This project is a new building or structure. te,county,town) <br /> di This project is an addition/alteration to an existing building or structure. ❑ S • ermits <br /> SANITARY SERVICE: PERMIT NUMBER: ublic,private) <br /> ❑SEWER &SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) tland/FloodplalN <br /> 1 3 '■ / horeland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionControl permit <br /> BASEMENT: 1ST FLOOR: TOTAL SQUARE FOOTAGE: j (sic. ,disturbance, <br /> C� w� S,Q ce 392 fil' ate) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2 eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ ♦ ♦ $ 2�, O DQ O and available options. <br /> (Please round to nearest dollar) �P <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes •No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project? r Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? II Yes ❑No <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 ®No ❑Don't know <br /> 7. Is this correcting a violation? UYes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —0 —0 <br /> 545-112(1/08) <br />