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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> 'Re t q10-71 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Al I< d f"l cs.SA _r-- <br /> Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 325— /7 M M 1Qr,,,;i,_ti, A, 3---3 5—Z/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (b if-Z/2-90 6(, ZI z -7°CC �F; 14c»rie� L,,"Ji c_ 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 w II/septic <br /> (City,State,Zip) (City,State,Zip) Setb ks <br /> PHONE PHONE Site Plan approval from <br /> applica le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loon plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑ PARCEL /_ frontage drawn to scale. <br /> NUMBER y ZS Y- L Z ,Q Z 3L,r y 7 <br /> TOWNSHIP: SECTION: <br /> 0 yo A .1/4. ,/4,/4. Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanit- •4 <br /> (pub lc,privat-) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DES IPTION: <br /> riC/1/' II ' 6 ! ,.D4.,.,::t-s#At; .. z ' ,, <br /> • This project is a new builuing or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: .,© „^ <br /> SEWER gEPTIC <br /> HEIGHT IN FEET: , NUMBER OF STORIES: (Not including basement) ,, <br /> AREA TO NEAREST SQUARE FOOT: /% <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,�' 4-'''''ti3 BASEMENT: 1ST FLOOR: ; <br /> 1"Z/m 4, TOTAL SQUARE FOOTAGE: j ,.'• ks v-nc ' 'F- <br /> 2ND FLOOR: �7 l <br /> 3RD FLOOR: ` � ':,4''' �� � 4 <br /> Ia-CI - <br /> • *t <br /> ESTIMATED CONSTRUCTION COST: c k�B <br /> (Please round to nearest dollar) ♦ •♦ -+ ♦ 'i ♦ $ ci.q 0 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes gNo El Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes RNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes Q 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? 0Yes Q"No <br /> APPLICATION MUST BE SIGNED <br /> \L_) . (Continue on Back)(4/08) ( ) "r <br />