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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER INAME 1 / i- ' <br /> i" a ' o5rih /] m /A' ❑ <br /> OWI6ER ADDRESS (Number,Street,City,State,Zip) Zonin 9 Status; CUP; <br /> 66 F- G �/\ t-:c...c S3 5P9 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> "e-?/9 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C9 N_TR/A,�CTOR NAME <br /> ���. ✓, 6�� iic 7' /�.e<4 / NC ❑ Site Plan including location <br /> AG NTADDRESS CONTRACTOR ADDRESS of well/septic <br /> 33/ /_- In e 5-ff- <br /> (City,State,Zip) (City,State,Zip) 1=1 Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> R5 O - 6c 5 0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> P ENT PARRCC1EL NUMBER: _ CURREN ZO ING: ACREAGE: <br /> '—' NUMBER c7!'•/ / 7�>-C /^/ s 5 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /,// J l/1-.... 1/4: 8- _ 1/1/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> E . L>z /e ix) pPec C+ <br /> CSM: LOT SU VISION BLOCK/LOT ❑ Sanitary permits <br /> is l S (public,private) <br /> PROPOSED PROJECT INFORMATION ST , :i <br /> PROJECT DESCRIPTI�ON: <br /> /2' ` <br /> his project is a new building or structure. it <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ress <br /> fSEWER PTIC •' '° <br /> HEIGHT IN FEET: 6 , NUMBER OF STORIES: (Not including basement) <br /> Shore) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ''d,';''''-r <br /> BASEMENT 1ST FLOOR: O ErtSiL31iy ; <br /> ✓�J "i + _ /?f 3 S j TOTAL SQUARE FOOTAGE , (s �,*�niw .e, <br /> U ->rr(� fi Ling/ ." ' <br /> 2ND FLOOR: 3RL._,JOk: + ; © , 7 - <br /> L!/ a <br /> ESTIMATED CONSTRUCTION COST: ,_,::•,,,,, <br /> ���� .',..,:ii� '�C1��y <br /> $(Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �p ��5 ' � options. .;+ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ENO ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ['Yes alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes e'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) • 'es ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Rido <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —0 <br /> 545-112(4/08) <br />