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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME r <br /> A C4 ad+ Soh 1-L ❑ Zoning Status;CUP; <br /> OWNER ADDRE S (Number,Street,City,State,rZip) Deed Restriction; CSM <br /> 56 Sri-loll/1 S-1-rip Uoi -1 il • Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> t - 56- 16/ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME / CONTRACTOR NAME <br /> JOYCJe ,a'r7C/h 6'7 ❑ Site Plan including location <br /> AGENT AddfbDRESS // CONTRACTOR ADDRESS of well/septic <br /> / 96 .cut'4 /"`eade LA. <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Mad i5c0 Gj1/ 53 7/ 3 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 605- .6-76 - /41e/-P 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 /> ❑ PARENT PARCEL NUMBER: /1 //� p CURRENT ZONING: ACREAGE: <br /> NUMBER ____O709-351-'76(Oti'-U 15- i - r 5,9 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ipolS a '/4:_ '/a'/a: ❑ Driveway permits <br /> i ADDR Ss: (state,county,town) <br /> s19 ,orlivi ( Li. <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION l REVIE" <br /> PROJECT DESCRIPTION: 'ate /: <br /> 2� S N S a 13 Zoning District <br /> . ®This project is a new building or structure. r , <P'' <br /> P��Lam? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ElRuralAc **s V. <br /> INSEWER SEPTIC (new/existing)' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ',---. •- 41 ;. / <br /> S I't�S a <br /> �/ a-r <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) "�i c! ' <br /> BASEMENT: 1ST FLOOR: <br /> tOStO[tfl` 7II . <br /> /? 5 + TOTAL •SQUARE FOOTAGE: j ( ,4+7 + AUdia ride., <br /> 2ND FLOOR: 3RD FLOOR: , I i . ) ,, N <br /> ESTIMATED CONSTRUCTION COST: EV € r, ..I. Burr,' <br /> �//' �� ,.,-.�.:t. ,. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ..+ ♦ ♦ 4) 7 b, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes gNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes El 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) ❑Yes sErNo ❑Don't know <br /> 7. Is this to correct a violation? Dyes Et/No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -+ <br /> 545-112(4/08) <br />