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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 /> `/,1/ [i 2 ' / <br /> g Status; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM A 24) <br /> ..375-0 o G,o DI ?✓Z9/G .S n/ 1°/'cQ/E w I ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3 S 0 IS '°D 3 .. ` 8Y d , of s•1 _ , •1 b . • . C 0 01 i M Site Plan drawn to sc- - <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and iI •- ._II-nsions JO <br /> AGENT NAME CONTRACTOR NAME 1_� <br /> AN c, C kca Q. ,1.. !'^G 7- C cwt; i�t 4❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • k -ll/se•tic <br /> P. tat Qn�c ► z � C � �n / z P,3/ 2"2 <br /> (City,State,Zip) (City,State,Zip) �� Setbacks 'AO <br /> 1111-- bJ c .Q wJ S---)'-5-7 141 -- II °i-- - - "1 1 .c 's-7 . .. <br /> PHONE / PHONE ��/ Site Plan approval from <br /> (0 C"G– -79 `Y -3 -77 (.0 ° %- 7 Q - 377 ap• ' .--- , • i•• <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> - f ,:i –,.�/ ' 9 1 i ty e -, c, , IA / Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ■ • Elevation of property <br /> ❑ <br /> NUMBER 88I I- 22-I_1515_0 4 - 2,0 ) j, p ys -•e drawn t. . e. <br /> TOWNSHIP: S r SECTION: IV .– <br /> Vs 1 Y Z 2 1/4: ' Y L INN: /IJ/ ;1/ V Drivew(_ •- . its <br /> ADDRESS: <br /> (Stat- •wn) <br /> 0,19-00 I <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> r1 du Sanitary permits <br /> 2 h I / (public, •rivate <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: / 461 k j"1�✓� 1 Zo mg strict / <br /> . N.This project is a rw buiNing or structure. 4Permitted Use 4 <br /> This project is an addition/alteration to an existing building or structure. . . <br /> ❑ P 1 9 9 <br /> SANITARY SERVICE: PERMIT NUMBER: — © RUB <br /> []SEWER SEPTIC 6 , <br /> ,", �y�f _ <br /> HEIGHT IN FEET: y NUMBER OF STORIES: (Not including basement) ri, + y i r <br /> /( ' / air 'a ' �a" =0 , of <br /> rr <br /> AREA TO NEAREST SQUARE FOOT: �ti id att chm <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: } s t , ,i• , <br /> Zl/ , . 2! 4a Sr 4, TOTAL SQUARE FOOTAGE: j (sl es, °"€ $ , i / <br /> l0 J ft t'ig/SCGE / / <br /> QNa-SL—GO . 6Acr/k,'C 3RB-Fre6Rf S7—cs o/o r, , <br /> ///5 6 // 7 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available• �i•; <br /> -► -► -♦ ♦ ♦ ♦ prr rti <br /> (Please round to nearest dollar) ©p pp <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑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'? EgYes 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) El Yes M No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545-112(4/08) <br />