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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 /> I 'L r r `'1 J /`'l4''C •• V''''74) ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3 10-( T;.,�5-�- (,yl{ Variance(# ) <br /> HOM PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 . 20 6 T h-/�'1 ( M 1AKS R y "1.__I-,x) , L.,- ❑ 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 ❑ 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/) Elevation of property <br /> PARCEL Q / r Q frontage drawn to scale. <br /> NUMBER � �d V Q(7 ( 1 2�� GL Z Z <br /> TOWNSHIP: SECTION: <br /> Q e tJ c, D e, /. 4'4//. ❑ Driveway permits <br /> 4 state, county, o <br /> ADDRESS: S P-S 3 <br /> (state, <br /> ) i t i T; y sr- C,:,. "" e U kro cam.; - ❑ Sanitary per ' <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,I <br /> �/ I � <br /> PROPOSED PROJECT INFORMATION STAF <br /> PROJECT DESCRIPTION: ti <br /> SLe & , c(D-&,'46 ,-, .4 sy.'J!(.'^'S 5' 4r5S1t I ' i - <br /> . ❑-This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: -Ut l ` .., j -, <br /> ElSEWER PeETTIC � <br /> � r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 'a� yr. " ay .,tl <br /> t N-% / <br /> (li t'4. , t e . /, e.r° Jlj <br /> torelar> l`v attachment) <br /> AREA TO NEAREST SQUARE FOOT: y <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ; <br /> BASEMENT: 1ST FLOOR: y <br /> r S I TOTAL SQUARE FOOTAGE: + i s • ''' d °° . <br /> fiIli <br /> 2ND FLOOR: 3RD FLOOR: ,, <br /> I9IO wL. . ey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ "♦ '♦ ♦ ♦ ♦ GO <X� a , .•t. .f , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes L.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? [l-Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes I: .No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# Z c 73) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) *es ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [.lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -* <br />