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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE •NAME <br /> an�i� De i3ri)lt Zoning Status;CUP; <br /> OWN ADDRESS (Number,Street,City,Sta tip> Deed Restriction; CSM <br /> 2;693 //�G'►i1S /tii/f '. ��D(J c LifOYJ Z�v� .535 cc/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI ADDRESS) <br /> 9fi& 3 t '/ ,pE aja 0633 ct'brt.i' �`� ✓' l' �O1"' ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan . . ding location <br /> AGENT ADDRESS CONTRACTOR ADD' SS of wet p C <br /> (City,State,Zip) (City,State,Zip) tbaCkS <br /> PHONE PHONE ❑ Site P a royal from <br /> applic wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dlane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE evation of property <br /> PARCEL l Id frontage drawn to scale. <br /> NUMBER of 11 -i9. Id p�P` .... C 1 I g <br /> TOWNS ECTION: ' <br /> S �,, S ,�.� ,/,/4. ❑ Drive a =-rmits <br /> ADDRESS: (st�._, ..u nty,tow / / / <br /> L� ' <br /> .°' P 7 as'tary p-rmits 6. <br /> CSM: LOT SUBDIV+SIGN BLOCK/LO <br /> `- ■\1;0^^^S Fr `fir - pu• ,private) <br /> PROPOSED PROJECT INFORMATION I IIE <br /> PROJECT DESCRIPTION: <br /> i ij �- �� r e�, yam,, ; Is <br /> ❑This project is a new building or structure. <br /> � ttk�t Us�� <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY S RVICE: PERMIT NU BE El Rural A•! <br /> SEWER 7SEPTIC <br /> HEIGHT IN E NUMBER OF TO IES: (Not including basement) <br /> 9 / •a:e ain/ <br /> AREA TO NEAREST SQUARE FOOT: ; <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) "; <br /> BASEMENT: 1ST FLOOR: , <br /> 33 6 + TOTAL SQUARE FOOTAGE: , / <br /> 2ND FLOOR: 3RD FLOOR: nE ), <br /> 33� w <br /> t�tIL3„Survey <br /> ESTIMATED CONSTRUCTION COST: and s ': " r 9 f t• <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ '♦ ♦ $ �I1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es 0 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑ es [NI() ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑ o <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 /> (Continue on Back) —0 <br /> 545-112(4/08) ) <br />