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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE ME <br /> et I oveu„' ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Num er,7eet, y,State,Zip)p Deed Restriction; CSM <br /> 7/31 /der ' 5- ,, l'/'gir�'G G�/ 530,o Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> Gof-U7—o'/ 4-(, 4'-3S7Z ehc/rq o Q /-on • C off'` ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAM i al j <br /> �tG%r WoOT,r #Oon"fratt,o�+ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRES of well/septic <br /> etc (,/4 rson Li <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> /11 6t w1//6v/ S3SS9 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 4o of- 39S- - (/7$ J applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://aEcNcT dane.co.dane.wi.us/) El of property <br /> PARENT PARCEL NUMBER:p CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER O/�/-14/41 7 300 �5 I ,y, ' frontage drawn to scale. <br /> TOWNSHIP: SECTIO : <br /> �;ri'S �/ / ,/4: ,/,/4: ❑ Driveway permits <br /> ADDRESS: p (state,county,town) <br /> 7/3 / Elder LP, Sun �rq:r���i�IJ( C3 6'1° <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJEC DESCRIPTION: RtvI <br /> �e�o�ce/�(�0"rat ��� QninCg NStiiC � t <br /> ✓c <br /> . ❑This project is a new building or structure. e <br /> 5❑C This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: I� rest / <br /> flSEWER SEPTIC ow/eXISting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ettattil " <br /> AREA TO NEAREST SQUARE FOOT: to <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,` Contra' ,1' ?, <br /> BASEMENT: '1ST FLOOR: �, <br /> j, TOTAL SQUARE FOOTAGE: + 9�,# :'% $ -, # <br /> 2ND FLOOR: 3RD FLOOR: <br /> VS-V741 Z � <br /> ESTIMATED CONSTRUCTION COST: „ssN <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �iG(�p • GD + CS <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. Is there 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 and are they�n agreement? col 2No <br /> 4. Has there been as zoning permit issued for this property in the past 5 years? Yes Z'No <br /> 5. Is this project associated with a rezone/CUP/variance etition/appeal# ) (leave blank i none) <br /> 6. Is a location survey required? (see reverse) EC 2 2014 ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [/]No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -+ <br />