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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> 01A/VElfttlat ---77,.a4/....e..4 <br /> r /7 OiAia) ,S asA-,. �_,,'�C1� Zoning Status; CUP; <br /> OWNS�ADDRESS (Number,Street,City,State, S ` a,, <br /> -1 ( o( Q. ,,�. � � �->v � ��� Deed Restriction; CSM <br /> LAN 4i-(1i-variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AG NAME NTRACTOR NAME <br /> . 'd L S ' (A- S ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> �'a /9<33D C-6 b be." t-I�l l 2ok <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> V-Z ((�� 3 1 �r 5358 Li Plan approval from <br /> PHONE PHONE <br /> � <br /> ,ag•-(qt�'7_ 01 C.f applicable township. <br /> E-MAIL ADDRESS E-MAIL <br /> ' ❑ Floor plans to scale, , l . l t ICI V-- <br /> PROPERTY/LOCATION INFORMATION (http://accessdanc.co.dane.wi.us/) <br /> El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCEL �i <br /> frontage drawn to scale. <br /> NUMBER O%SID-O9 tl `l�ZO— S C_2_�DO�1��oo• / D, Z g <br /> TOW SECTION: <br /> U V• 1/4: 1/%/4; ❑ Driveway permits <br /> ADDRESS: / (state,county,town) <br /> T O ( `LO C 7 k(1"j6"--1 5� CI-1 permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION ,; S• • EVIIE <br /> PROJECT DESCRIPTION: (� /% <br /> hew � � a'.. 2 x S f-�� x t csL d > to t <br /> • ❑This project is a new building or structure. Perm ifted Use? <br /> This project is an addition/alteration to an exi 0 sting building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> (SEWER fSEPTIC �� <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) 5%'. <br /> _� f <br /> and)and •*Il4ain/ <br /> AREA TO NEAREST SQUARE FOOT: ,, .„ <br /> 0 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> LI BASEMENT: 1ST FLOOR: <br /> Ero trW �it <br /> 1 TOTAL SQUARE FOOTAGE: ,, � + • , <br /> 2ND FLOOR: 3RD FLOOR3-61 --�1 <br /> ling/a <br /> Q Riview s mil.„ N� <br /> ESTIMATED CONSTRUCTION COST: , } <br /> (Please round to nearest dollar) ♦ ♦ "♦ ♦ ♦ "♦ ,..)/ �0 �, e4,— <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? <br /> El 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 in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ❑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) -♦ ♦ -♦ <br /> 545-112(4/08) <br />