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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 /> '(t C_ Lk 261.(0 ❑ Zoning Status; CUP; <br /> OWNERADpRESS (Number,Street,City, ate,Zip) <br /> 331a3 0 a►4 Deed Restriction; CSM <br /> a f " ‘ �^ Variance(# ) <br /> HOME PHONE LL PHONE E-MAIL ADDRESS <br /> fY7- 8-0-73`13 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME NTRACTOR N E <br /> 'r'ati� `' � r w C, ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR U Q,p RESS 1 {� , of well/septic <br /> 3 t w`,�atf c pp I kJ� , <br /> (City,State,Zip) (City,State,Zia) ❑ Setbacks <br /> PHONE PH NE ❑ Site Plan approval from <br /> ''vg-�y s -86 5 a applicable township. <br /> E-MAIL ADDRESS E IL S( <br /> j-' A IA DD� c loo @ eSN C' e — ❑ 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 /> ❑ PARCEL �S ,ObiD - 3 3la61-) ,/� �j0 frontage drawn to scale. <br /> NUMBER (/ �.J <br /> TO (SHIP: SECTION: <br /> VC( n V) 1/4: 1/31/4: ❑ Driveway permits <br /> ADD Ess: (state,county,town) <br /> 3 qa t`i`41 - c"u� 1/ w: . 3-e' r ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION , . , <br /> .43';;;"-Li:',,,1:4—REVI-Er <br /> P JECT DESCRIPTI I . t i 1 i <br /> D,Qa. r e 0ep 4(e F//c'-"S j Pa4koe I " ti I© � 13 Zoning <br /> . ❑This project is a new building or structure. <br /> la t#(.1..-.1.1=:.,1 Use? <br /> IThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural 4 °'- <br /> EWER nSEPTIC (sere ~� ° <br /> HEIGHT IN F I3:I t% NUMBER OF STORIES: (Not including basement) ❑M l�y�„ <br /> /r 1 *.. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ." • of s{! s .TIt <br /> 6 <br /> j TOTAL SQUARE FOOTAGE: ,' �q ,,. " ban ex <br /> 2ND FLOOR: 3RD FLOOR: ,1--/ t) -CI- linglet ess) <br /> QTY <br /> Q Raw ILO •' .el <br /> ESTIMATED CONSTRUCTION COST: ©p z -,-, pSigf;„ <br /> l <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ .41. 1 3` D <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 El 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) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 <br /> 545-112(4/08) <br />