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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME aIlC`I- <br /> Ja w^'j 0 G 4 ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 35 LOB L+ 1 cYG G lie _ Variance(# ) <br /> HOME PHONE' CELL PHONE E-MAIL ADDRESS <br /> SPD S. lA ?' a c d -( �S@o'tna-24)•t- ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 11 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER X110 — 3S)—k11510-5 2- a p•3tOl frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Ot*O‘fl D(' GL COWL V.■) ( 1' 35 1/e: NI V%) 1/41/4:S � ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> SSSi 9j C h(,VtS Dr ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> A S�lit Hitt-I aal/ I� . <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT D SCRIPTION: <br /> Shtd Ly�� <br /> i a <br /> . .This project is a new building or structure. -'� <br /> �8r31�H� USe�ry; '- <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: q PERMIT NUMBER: jral�re <br /> % SEWER SEPTIC ewlex <br /> HEIGHT <br /> 1 01 IN FEET: NUMBER OF STORIES: (Not including basement) „ 4,„ . � <br /> AREA TO NEAREST SQUARE FOOT: Stt• 4 r% <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) s <br /> BASEMENT: 1ST FLOOR: <br /> Q. . rot emit <br /> 1 4, TOTAL SQUARE FOOTAGE: 1 . :disturbance, <br /> C/ A tinSCGe54 <br /> 2ND FLOOR: 3RD FLOOR: 1 ?•�•., <br /> yv D R Si ..-- i. ur�j `" <br /> ESTIMATED CONSTRUCTION COST: , 8 o � <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ I ati c. ; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No El Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No 1=I Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? UlYes fl No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# I t[09 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) iYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes allo <br /> S- ` 62U <br /> �- APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />