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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ' <br /> 649'. � CIfm8s El Zoning Status;CUP; <br /> OWNER ADDRESS (Nu ber, tr t, ity,State,Zip) Deed Restriction; CSM <br /> 75$3 AWYIroUPJI Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> at-V .. --)Y 1 10!-)1)- 3) & or- 1 U ' i •d ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CON IRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON RACTOR NAME <br /> $Ito 9S otjie7' ❑ 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/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL 0909 -06 I,91o`''—D GG, / frontage drawn to scale. <br /> NUM <br /> TOWNSHIP: SECTION: <br /> UI� q '/o: '/a'/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 65) 0 1WOO/ 0 ❑ Sanitary permits <br /> CSM: OT SUBDIVISION BLOCK/LOT <br /> 76 / <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION F R�lEw <br /> PROJECT DESCRIPTION: J le r <br /> 440 t2ehor;le 3/V,�e / 'P a04. uipmf U mcgDistrct <br /> This project is a new building or structure. 0 ?` fitted Use?? <br /> This project is an addition/alteration to an existing building or structure. ,, <br /> SANITARY SERVICE: PERMIT NUMBER: /'� em ura ' <br /> SEWER SEPTIC '-©0V /ekistie <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including ba ent) <br /> G Wetland/Flood lail� 4 <br /> Y / Shhorelattd (a tchm <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a E • 4, tr , <br /> , ' <br /> BASEMENT: 1ST FLOOR: ���, <br /> p� 1 TOTAL SQUARE FOOTAGE: 1 , , ,arnfe, <br /> 11 ' <br /> 2ND FLOOR: 3RD FLOOR: <br /> 70)93 - <br /> Li t Surveil <br /> ESTIMATED CONSTRUCTION COST: r an �R <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ -i∎ $ a7 5-0 0 0 , U °',,,, _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo ❑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? N'Yes ❑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# /a 6 g 0 ) (le ve 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? ❑Yeso <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ♦ -+ <br /> 545-112(4/08) <br />