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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C ,STOMER TO PROVIDE <br /> OWNER/NAME /c <br /> lipi4 T Fleifrfi l U oning Status;CUP; <br /> 6'W 544(N l�r,Srjy,Sate%ip) Deed Restriction; CSM <br /> lr Y S 4 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> `� r�3ac- 4 �, Si Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION a d includes dimensions <br /> •GENT NAME CONT'•_CTOR NAME <br /> ite Plan including location <br /> AGENT "DRESS CONTRACTOR ADD' S of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ ite Plan a oval from <br /> plicabl ownship. <br /> E-MAIL A"'RESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NU BER: CURRENT ZONING: ACREAGE: P P y <br /> i— NUMB L b ?./060g-._Z57—r e� Ri/_ R.�7 frontage drawn scale. <br /> NUMBER Rif <br /> TOWNSHIP: SECTION: Y <br /> TOWNSHIP, q. -� 1/4: 1/41/4: 0 U ❑ Drivewa ermits <br /> ADDRESS: / (state ounty,town) <br /> • — <br /> . 'I1 <br /> A :.0.4 � ❑ Sanity •ermits <br /> csM LOT S SUBDIVISION BLOCK/LOT <br /> (publ.',private) <br /> PROPOSED PROJECT INFORMATION f F REVIEW <br /> PROJECT DE RIPTION: 7 t f <br /> erQ5P_ , 71P �%Zx tl'(' � ,,. " <br /> ■ This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. „ ".r, ` <br /> SANITARY SERVICE: PERMIT NUMBER: z ,_,e . ,. <br /> SEWER TIC r, /° $ <br /> HEIGHT IN FEET7(:(- NUMBER OF Li:IES: (Not incl ing basement) . ' '£ <br /> / AREA TO NEAREST SQUARE ter,.; <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> r"-- 2U"P"/e7L' 4, TOTAL SQUARE FOOTAGE: (slopes,d 140::,,,, f <br /> 2ND FLOOR: -3RD FLOOR: 7�J V �/ <br /> C <br /> 32'�*741,,,-;'1 , 1����l��l�l��tF� � <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �r,�,. ;,, . 00� <br /> (Please round to nearest dollar)( ) �c, OO „te , y <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes El No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes rg 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 5,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 Is-No <br /> NW ? 1 O APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />