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ZONING PERMIT APPLICATION wwcountyofdane.com SUPPLEMENT to Web-App # <br /> w. <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> NER NAME <br /> D f Rue r∎A rL )r r Zoning Status; CUP; <br /> OW RAD ESS (N414J/um :Street,City,State,Zip) Deed Restriction; CSM <br /> G 41 CEL CELL MT E-MAIL ADDRESS <br /> �s i 5 S 7a .°24,j�, Variance(# ) <br /> HOME PHONE <br /> 0/7 : '( -.I . - - `1' Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 114-it-e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 4etbacks <br /> PHONE PHONE E 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/) <br /> PARENT PARCEL NUMBER: CURRENT Z NING: •CREAGE: evation of property <br /> El NUMBER —CL ei/, l33 CM 40.-- — 4 2 6 t2 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 1 L(kt M c,. N b 13 'L--(o '/a: '/4'/a: Driveway permits <br /> ADDRESS: r' r L� (state,county,town) <br /> -0 41 w y 'EG �41 t H o R E- IA)I . .5' 5/? . - - a`I 3 L Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: vott <br /> (3 ? S--0 r„e&d,64-11 4 sh e_; 'ti.zon-, „1,--: -,,,:,/lx .,„,- - <br /> . ®.This project is a new building or structure. , i ✓ <br /> 54 Pitted U <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 4 Rurat.Addre* <br /> nSEWER lyiEPTIC T 1"- ° °) " <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> IS, 1 Wei • s c6:- <br /> Shor t (a ct ent) <br /> AREA TO NEAREST SQUARE FOOT: �6F" <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) . , <br /> BASEMENT: 1ST FLOOR: "sio � ; <br /> / 4, TOTAL SQUARE FOOTAGE: 4, 4 �5,disturb- , <br /> 2ND FLOOR: 3RD FLOOR: ! IIIVJJJIIIIJJJJ ` �� ? <br /> RP 0,11 (odsurvey <br /> ESTIMATED CONSTRUCTION COST: -10 ♦ ♦ ♦ ♦ ♦ and abl , <br /> xii <br /> (Please round to nearest dollar) $ WO <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 g No ❑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? DYes © 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) 0 Yes ©No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes RI No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) <br />