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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 /> ? Q <br /> 14N J 4 li c 'Z Zoning Status; CUP v 2 //; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM/4 2/ �) <br /> 37.5-0 o Az) T.,.40J4 7✓!9/G S '/ /�'/'c ,4YE w I ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3 S- 016 41D 3 s — 8Y d , w $► _ I/ ./ b . • • ( col ( M Site Plan drawn to sc. - <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and i i •- u nsio s 10 AGENT NAME CONTRACTOR NAME <br /> _& Y ,%/1- 1?42'1 4,41..ir), i f r C rvr;- -r...t. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • , -II/se•tic <br /> (City,State,Zip) (City,State,Zip) U Setbacks -5-75.2--/- 2--> /0 <br /> "Yrt-,. N a�� w1 s—)--.3-7 r►1 T-- // C.VO L.✓ i S-3 S" <br /> PHONE PHONE i Site Plan approval from S <br /> CD "t‘,.- '7 9 16 -3 '7 '7'7( 6, U %- 79 - 3 7 '7 y ap i ' 1 <br /> ` i i. 4- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ` f -, ,,k : - - 91'e y w e . c. -, Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER:/ CURRENT ZONING: ACREAGE: • Elevation of property•❑ PUMBER e 1 1— Z 2_l .-g515-0 A — 2,C{' ) /r O �S -.e drawn t. - e. <br /> TOWNSHIP: SECTION: / .- <br /> S U V• ry z z ' : I V L' '/41/4: 4/ ;1/ V Drivew its <br /> ADDRESS: (stat , ount wn) <br /> CSM: LOT SUBDIVISION BLOCK/LOT u Sanitary permits <br /> 0 2 h I / (public, •rivate <br /> PROPOSED PROJECT INFORMATION // STAFF REVIEW <br /> S <br /> PROJECT DESCRIPTION: / 7- <br /> This project is a ew buil ' or structure. 40 o_ <br /> ❑This project is an addition/alteration to an existing building or structure. FrfrE <br /> � <br /> SANITARY SERVICE: PERMIT NUMBER: at <br /> FISEWER SEPTIC i 1 } ,' <br /> HEIGHT IN FEET: y NUMBER OF STORIES: (Not including basement) ,A. <br /> /CQ 4 P . andl�p(ai y <br /> r a attach ) <br /> AREA TO NEAREST SQUARE FOOT: y / 4- <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) . , { <br /> BASEMENT: 1ST FLOOR: `-'°' <br /> S--- 1 TOTAL SQUARE FOOTAGE: + �y , ' ± '_ * *` ;;n <br /> EMBSE9AR'. <br /> &,G C 3RB'FL96R• J 9 0 op i /yam % 1r , <br /> /1/3c. j/ S- 7 0 w��c�rr,urvey ,„ <br /> ESTIMATED CONSTRUCTION COST: arti' d <br /> (Please round to nearest dollar) ♦ ♦ ♦ • ♦ ♦ /1 ifq - 1 <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? [gYes 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) ❑Yes rt"I No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) --0' -► -0 <br /> 545-112(4/08) <br />