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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 /> VYl lC>X- i i w t<e)3/U0C / Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> /17g2/ s��z 1t C is -�� Deed Variance Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Variance(# ) <br /> 9 437-1/26 q' i,r�' 13--32!`7 Pt IC W J OAi /�;L ,�� ,, . C q Site Plan drawn to scale <br /> AGENT INFORMATION �CONTRACTOR INFORMATION LCI and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> U(X 1,0-e(r Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) [/Setbacks <br /> PHONE PHONE <br /> ® Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS �-•,( <br /> 12 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACRE 41)01 &Elevation of property <br /> PARCEL <br /> NUMBER U4/S�wsoc-�/'S P� ' ) g� frontage drawn to scale. <br /> TOWNSHIP SECTION: r <br /> Pe o(l 7 )-S-G 1/4: UJ %/: /U E briveway permits <br /> ADDRESS: (state,county,town) <br /> i o a2I 5P v'I',u-rp e !o, 1:5(A1 ass ()L - <br /> C <br /> 6-3s 17 Ilr <br /> SM: LOT SUBDIVISION BLOCK/LOT unitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION RE I EW <br /> PROJECT DESCRIPTION: <br /> 4i ttllt " <br /> • El This project is a new building or structure. �� �' <br /> fit it U <br /> This project is an addition/alteration to an existing buildi ,ng or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: k#[ 7 <br /> i <br /> SEWER SEPTIC , � t <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Ot, ....-'',"* 1:4 r .•'...: v., <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: °j � • g st <br /> j TOTAL SQUARE FOOTAGE: j <br /> � <br /> 2ND FLOOR: 3RD FLOOR: 1; : s <br /> ESTIMATED CONSTRUCTION COST: ' � _ <br /> (Please round to nearest dollar $ � n,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0Yes 2l/I o 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes 04 ❑Don't know <br /> o <br /> 3. Have you talked with the township about your project and are they in agreement? 'es 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? U Yes LIallo <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) fYes L2'V ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Vo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —■ —■ <br />