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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 /> )(De M' � R� El Zoning Status; CUP; <br /> OWNER ADDRESS Street,City,State,Zip) Deed Restriction; CSM <br /> 2Ii& i) PbS/A'°- 0(5. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,j, 6,9' -99/ S 1►-E 4D 1 �) r -6 , <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ 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 /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURREN NING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL 5610 M 053 r..� _ ,/ n3 , .2-> frontage drawn to scale. <br /> NUMBER `t <br /> TOWNSHIP: SEC,T�ION: l <br /> `�L(,�0 1/: 1/4%4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> l &, () SS4- /4005 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> � AC-27 Z � l «TI- U gul o PROJECT DESCRIPTION: `��l J L OA u V e,LC Set 1 �(_ 4�,1 7l � .r14L Ot= 4-0 5,x '"..v7 ri ( GcSs2 ems) - <br /> ❑This project is a new building or structure. �I <br /> El-ThTs project is an addition/alteration to an existing building or structure. 1:441'u, <br /> SANITARY SERVICE: PERMIT NUMBER: ral ° id f i�3EWER nSEPTIC n : ) y 4 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ;, <br /> i , *tSp , ' <br /> $t);' <br /> hyv 4 ��(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> atII(y <br /> Y ; d b � F <br /> BASEMENT: 1ST FLOOR: �' ' <br /> j TOTAL SQUARE FOOTAGE: ,°'•• 4;,distu <br /> 2ND FLOOR: 3RD FLOOR: <br /> 4E_� tll` <br /> 4-n 50 ESTIMATED CONSTRUCTION COST: Rnavy � J <br /> (Please round to nearest dollar) "� ♦ ♦ ♦ "♦ ♦ `I �: <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [1 es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ARV` es ❑No [-Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? im! es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? !i es ❑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 - No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes," No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) <br />