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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME At 14 ,e PW 2g./ /7 <br /> ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) q�eed Restriction; CSM <br /> .?.8 d s /JC tb v v� --N / / l/`2-c-c(7 5 7, 1ti, --' '-Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /01'o) 1/s-- 9 2 4'i/i^e"''/'- 6'`ile",- A'°I .ii'c.,,-(i ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ✓ J✓Of , CONTRACTOR NAME Cc c.. <br /> Wt5 092i► li I f j " " 4L-lP'^, ]) _5, pines 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ("27 7,Q ,. 171 X p ,1 --- <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> (/00b' ) d d-o —6 3 g/ ' applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ( <br /> 7 <br /> -,, C -4L y e Prioa 12p.1,PS� ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> �PPARENT PARCEL NUMBER: CURRENT ZONING: <br /> ''N ACREAGE: ❑ Elevation of property <br /> UMBER 07, ,g- 3"/_6 72?_© , S , e frontage drawn to scale. <br /> TOWNSHIP: Ai <br /> 4'/ _ SECTION: <br /> 1/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: r (state,county,town) <br /> n't- /) t�- ? /�� e .)r 3d. 7. IV'e/rQnl� <br /> CSM: LOT SUBDIVISION , BLOCK/LOT Pig permits <br /> 7 Ce;pnvt voosO Tart''Of (public,private) <br /> PROPOSED PROJECT INFORMATION ST E`Rim <br /> PROJECT DESCRIPTIO <br /> / -Sf/- � 0 V` 1-1 <br /> %d <br /> . his project is a new building or structure. ;, <br /> �'rermliteAPse7 <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ,U Rural A <br /> F1SEWER 17PEPTIC /3 ---/. - 0 o06 O ( e lifin % <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> 3a - O a 4,We' ,a ®e.e <br /> AREA TO NEAREST SQUARE FOOT: SlhtNe) 1t) tattdment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> 8 '" ' 7/ / 4, TOTAL SQUARE FOOTAGE: 4, t, ,L,-�, 65- <br /> GS / �' /a <br /> 2ND FLOOR: 3RD FLOOR: <br /> . /5 [O p �� <br /> i,e e <br /> ESTIMATED CONSTRUCTION COST: ..+ ♦ ♦ ♦ ♦ ♦ Btl(#Sy3 �0 � <br /> (Please round to nearest dollar) $ Jt—f� x <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes tlo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? El-Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [ to <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 E.No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [ Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />