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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME j� v P / <br /> ,Q/Ci1 /14M h( 4— ,;/,1 /� e// - /ia�"'lief:/ ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Streetttty,State,Zip) '�^�J / U Deed Restriction; CSM <br /> HOME PHONE k lit) IIlP!!5/ �6n/ E-MAIL ADDRESS 53591 Variance(# ) <br /> ,'0$ $73- Britt 601' 770 - 37V ' a a(aw►4cI IN ahco. ea Ai ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONCTOR N E <br /> Aeve rl Kapileti ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTO ADDRESS V of well/septic <br /> 79151k 4 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> h u5kbrt 1 GJ q- 5-331 <br /> PHONE PHONE ✓ ❑Site Plan approval from <br /> 60$' 770 --3 7Y7 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRES <br /> a a f Q M"tbc I. - 44160 , corm ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.daue.wi.usn ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL ER b$710(($X 00 11 fl ?H_p? 7 1/d frontage drawn to scale. <br /> NUMB <br /> TOWNSHIP: SECTION: <br /> bur k� K. �/ '/4: '/4'/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1 & z/ - kao,3r- <br /> ❑Sanitary permits <br /> CSM: LOT ! SUBDIVISION BLOCK/LOT <br /> ti ! S.-0 <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: a a <br /> /0e(A) houses g <br /> This project is a new building or structure. w <br /> This project is an addition/alteration to an existing building or structure. ,,, <br /> SANITARY SERVICE: PERMIT NUMBER`: /��Q &. °i 'Mr; A ' <br /> EWER PEPTIC 1,3` �0/7 " ov(JCJ `l fir, , _� <br /> s <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> D AREA TO NEAREST SQUARE FOOT t.t <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOG <br /> �/ , �) ' 4,:: ... <br /> if iT 3 3 j f + TOTAL SQUARE FOOTAGE: j ,,,,,„,-13 ,;;:,.,,,,,!,,:i E` = <br /> 2ND FLOOR: (/ 3RD FLOOR: 5' 3 3 A _ ; <br /> ESTIMATED CONSTRUCTION COST: q t. _I T, �. .„, <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ —∎ $ 0?.75r 6V0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 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 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -+ ♦ —► <br />