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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STONER TO PROVIDE <br /> OWNER NAME <br /> 5 Co 7T ri y '- In Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> (Deed Restriction;CSM <br /> 3I -2_ c c U I e 2.D m-&cA 1 S o n t:T .531 i t Va fiance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> G 015).) 0 LI 4 60 t Zat I R S CO Tr S ( rf✓vi o c(ej j✓1 co AA `t Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION ,n includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 5 c O Tr Al e. n I/ S' a Plan including location <br /> AGENT ADDRESS P CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ e Plan proval from <br /> plica e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURR TZONING: ACREAGE Elevation of grope y <br /> ❑ PARCEL ©t�_ e ^ a?4'o,, `I R^ I i t. frontage draw scale. <br /> NUMBER �D �lo�C 1 sit <br /> TOWNSHIP: SECTI ,� ` <br /> .ill J =� v c D u•t✓\ 1/4: `�.1 IN) 1/41/4. ❑ Drivewa ermit <br /> (state ount own)ADD l:� Z � V ' �� �� <br /> CSM: LOT SUBDIVISIQ (`'td ,D 1YAK/LOT anita permits <br /> /S r�® ► V1fi� �O pu• c,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTIO e <br /> ADD K; c iv • _ �ct <br /> c <br /> ❑This project is a new buil ing or structure. <br /> pThis project is an additi /alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ,ral + ,re <br /> SEWER SEPTIC (nor 13 <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement) a � l <br /> I / W i 4 f i i7 g� <br /> AREA TO NEAREST SQUARE FOOT: fE > r <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ' Em '1 <br /> I s rt ''Q ''' t <br /> BASEMENT: 1ST FLOOR: y � y v %' <br /> eit.00 1 % 11 j TOTAL SQUARE FOOTAGE: > s a 0 ?� <br /> oT <br /> 2ND FLOOR: 3RD FLOOR: -7 <br /> R on Sony <br /> ESTIMATED CONSTRUCTION COST: 1 4 <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ ca S U)� ±, s <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LIYes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0,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? (0 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 El No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes No <br /> r APPLICATION MUST BE SIGNED <br /> / � (Continue on Back) -∎ ♦ -* <br /> 545-112(4/08) III <br />