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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ❑ Zoning Status; P; <br /> OWNER ADDRESS (N,mAb,yr,Street,City,State,Zip) <br /> 3a7g /vl , t,r,� I F Deed st ' ion; CSM <br /> �"'�S t °`"k Varian # <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 46Y-r.58-iiRea o? ❑ Site Plan dra to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and incl d dimensions <br /> AGENT NAME / CONT,�°� TOR NAME/ 1 <br /> I) Le ,4f NJ ,, - ! - A► imvi1/ L ❑ Site Plan incyl ding location <br /> AGENT ADDRESS F ONTRACTOR ADDRE � /� of well/s p iE <br /> 023t�y 1 r 4 �=-� <br /> (City,State,Zip) (City,S tot/Zip) i / ❑ Set 9G‘ <br /> PHONE PHONE v ❑ Site Pla ap rom <br /> z,6 '- 7/2 - J O sr applica le ns 'p. <br /> E-MAIL ADDRESS E-MAIL ADDRE.S <br /> ,� i A e. WQ ,4 ,4o•J Floor plans trrscale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.daAnc .us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRE TZONING: ACREAGE: <br /> ❑ PARCEL a ( I S 7 frontagetta in to scale. <br /> NUMBER ( • <br /> TOWNSHIP: SECTION: <br /> 8)o 191,- i 44rB IJe +/4: +/4+/4: ❑ Drive �y f mits <br /> ADDRESS: ` (state N +, town) <br /> 30707 f'1��tKSte '-. ` , /`c 'e. <br /> CSM: LOT SUBDIVISION BLOCIVLOT ❑ Sani a+•-' s <br /> (pu.'ic, . va -) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ,2e-A0 , <br /> H x141 to k DZ <br /> . ❑This project is a new building or structure. y '/ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBE : la RU� .• �s <br /> ri SEWER SEPTIC �EW "" <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> i? i t .a!C nt <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) - n • <br /> BASEMENT: 1ST FLOO <br /> �` /7 j TOTAL SQUARE FOOTAGE: j ° + i , � , <br /> 2ND FLOOR: 3RD FLOOR: 00' y, 4/ <br /> ESTIMATED CONSTRUCTION COST: <br /> Please round to nearest dollar ♦ ♦ ♦ ♦ ♦ ♦ L'� D a r� g, # t t,,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes [-coNo ❑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? [.Yes ]No <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) Dyes zeltio ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ' <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ --■ <br /> 545-112(4/08) <br />