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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME D <br /> J(-In f Pace 5 t/lati 19 ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State<Zip) Deed Restriction; CSM <br /> ?773 IF Cf tVi Pki Dr' COttopie G/vv°F u" ' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,cP 3"/C-1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (WOI(TO KO (4 Y5 ❑ Site Plan including location <br /> AGENT ADDRESS CON,TIACTOR�DRESS_v /1(�/`4 4). c33) well/septic <br /> (City,State,Zip) (City,State,Zip) 7/� 7 ���� El Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> C��) ['3-0 76.7 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> or t x(((11 ® Vgiic0,CO>M ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE T ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL 07// ,3 J3.1f j 7 i� 1 -c7/7 frontage drawn to scale. <br /> NUMBER l <br /> TOWNSHIP: SECTION: <br /> cot t4-91° Gfove ,/4. ,/4,/4: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRES <br /> 73 L[ Cre5 6 14 e tti fir, ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION h/ BLOCK/LOT <br /> Ld&- v (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: , t ST S aavt(o <br /> . ❑This project is a new building or structure. a _ Ise?� <br /> ii <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: El ss <br /> fSEWER SEPTIC (navy/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> i <br /> o El Wetla d/Flood lain! <br /> :; �'�%! 'elm:(attachment) " <br /> AREA TO NEAREST SQUARE FOOT: i s <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �' <br /> �4ossrtitrol t <br /> BASEMENT: 1ST FLOOR: 2� <br /> I, TOTAL SQUARE FOOTAGE: j s,d= � <br /> ,a- �,. <br /> 2ND FLOOR: 3RD FLOOR: / cgL <br /> r a r� <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦♦ ♦ ♦ $ (, / O i f i one." <br /> (Please round to nearest dollar) (� Q <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 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) Eyes ETlo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes p No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />