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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME.,.—Al ,^�_ , <br /> ,!L/I / r�L -Q^� a‘..1t4v .❑ Zoning Status; CUP; <br /> OWNERADDRESS (Nu��,Stre t,city,State, i) , Deed Restriction; CSM <br /> `� (vO ( l-� `(L . - Sc�. 2 011 ytil'a S Variance(# ) <br /> HOME PHONE CELL PHONE ' E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C TOR NAME <br /> t Q- _ �"' v4 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRES of well/septic <br /> L TC ^-�- 19 3 CV eA.._(-kola `mil <br /> (City,State,Zip) City,State,Zip) 2} C358 El Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> ee0g LoC.-f 7 ^ 0 t H °( applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> be S, /,,Q∎ ' 4 tt.k Coy ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONIN,Q ACREAGE: <br /> ❑ PARCEL f' ���^ 6-.z P't( Z� frontage drawn to scale. <br /> NUMBER 8��— p8� 2- � - /��, <br /> TOWNSHIP: SECTION: ✓p 41741 g <br /> VV'�r .,.-Q_ ,V4. ,/,/4. ❑ Driveway permits <br /> ADDRESS: //// (state,county,town) <br /> 5/D( Z70c?tL-l>✓c-44 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION 'STAFF REVIEW; <br /> PROJECT DESCRIPTIO <br /> 404- - <br /> t� 11� S �� ‘ sal <br /> . ❑T 's project is a new building or structure. , <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: al ,s ess <br /> SEWER (SEPTIC ew! ' , a •) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 4,, g <br /> S = att a s - )4,! <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) II <br /> L'Y �/r <br /> YF � ' <br /> BASEMENT: 1ST FLOOR: <br /> � <br /> 4, TOTAL SQUARE FOOTAGE: 4 s +j'i, r y,' <br /> 2ND FLOOR: 3RD FLOOR: €Ilhng/a' ; <br /> 4- ,,a /•R= rn►Lin Survey <br /> ESTIMATED CONSTRUCTION COST: „ <br /> (Please round to nearest dollar) ♦ - ♦ "'• "'♦ ♦ $ 09E) a d- ,..,,8 c� <br /> i °. <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 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 /> 545-112(4/08) <br /> (Continue on Back) <br />