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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 /> zavvt co'" [ctoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> g(31 S6A€T\a A Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME f _ CONTRACTOR NAME <br /> V iV\C-e. La t,,ce v\b 6-1 Q Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> [V\ Q Asso Ci a*.S <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> cl a5 (J0.k ov- -v-e, <br /> PHONE —7 PHONE ❑ Site Plan approval from <br /> V ko�.l S(M r (A S� 1) 3 --�� ( 1 CO d0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> v 1 ou. , Mae-eUSSUC+0C- COti+-1 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: �1 CURB TZONNIINNG. ACREAGE: ❑ Elevation of property <br /> El NUMBER O pV1 Sd-`4 9OW I t/\ /4-5 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> I-A ,/4: ,/4,/: Driveway permits <br /> ADDRESS: (state,count town <br /> y s-a � A Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROJECT DESCRIPTION: , i1 (\ <br /> a - 3�e k+ex� ■)ova l( x 33 a) .)a-'9 X Z tirr <br /> . This project is a new building or structure. t e' se r <br /> ❑This project is an addition/alteration to an existing building or structure. K� Y.' <br /> SANITARY SERVICE: PERMIT NUMBER: u t' ••,i �� <br /> SEWER XSEPTIC > � • <br /> HEIGHT IN FEET: tom\ NUMBER OF STORIES: (Not including basement) r, <br /> ✓ + €3 : ! •,a r <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shot _ attar � t) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: j <br /> ,, TOTAL SQUARE FOOTAGE: 4, '•• •�,t?„ , <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 414 -' 5- , 't-i• '11CV, <br /> ESTIMATED CONSTRUCTION COST: <br /> availai�op#i <br /> (Please round to nearest dollar) 4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes h No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes ►� No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? SYes •No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? El Yes ►2 o <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 23• o ❑Don't know <br /> 7. Is this to correct a violation? DYes r/ o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -+ <br />