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Y <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> 4 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA E <br /> D-e c h S e►�.er Picrier <br /> g <br /> >( OWN RADDRESS (Number, reet,Cit ,State,Zip) �ning Status; CUP; <br /> / \ � S Deed Restriction; CSM <br /> HOME PHONE �CELL'P fNE E_V�f Dry Kd Z S�- Variance(# ) <br /> LADDRESS <br /> T 31-� _ 0 I's 0 a .I:I,SO K J 00.1-4 i , U S ill Site Plan drawn to sca - <br /> AGENT INFORMATION I CONTRACTOR INFORMATION an. ' - --- - - - - <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENTADDR CONTRACTOR A.DRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) <br /> Setbacks CD , eX,,� <br /> PHONE PHONE <br /> ❑ Site PI royal from <br /> ap lic a wnship. <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 ZONING: ACRE E: Elevation of property <br /> IDPARCEL <br /> NUMBER 06o7 -3y3-6',iv- / R--.). frontage drawn to scale. <br /> TOWNSHIP: II SECTION: <br /> r- f: OtCXIP 31-.1 1/4: 1/a1/a: ❑ Dri wa ermits <br /> ADDRIs: (stat , ounty,town) <br /> I .'7 L)0.S ,i o^ S-1- <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ San .ry ! -rmits <br /> f"� utue,,,,,, a •>"S (publi .rivate) <br /> PROPOSED PROJECT INFORMATION REVIEW <br /> PROJEC,ZDESCRIPTION: S'xl- <br /> K nn <br /> P Q� e.Y•S1�n� 'Pt !'»! -�sf�c- � �� N <br /> ❑This project is a new building or structure. ,4 <br /> z��e ° Itt fey <br /> This project is an addition/alteration to an existing building or structure. ' <br /> 4 .- <br /> SANITARY SERVICE: PERMIT NUMBER: f Ci c SS <br /> SEWER SEPTIC J: e ' , <br /> HEIGHT IN FEET: NUMBER OF ST RIES: (Not including basement) <br /> ,......)-- °R17;W:'!` -4A;41:-/''Oa* ; " <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .f /* <br /> BASEMENT: 1ST FLO,-: l k .g " • ; ` <br /> 0. 'lo j TOTAL SQUARE FOOTAGE: 4, (- , -+-.! <br /> 2ND FLOOR: 3RD FLOOR: L <br /> 9 1' -- 19 - 1'; ,. <br /> Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ _S /( '' <br /> (Please round to nearest dollar) / / <br /> On S.'R /00, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ErNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes t❑'No ['Don't know Ctc <br /> 3. Have you talked with the township about your project and are they in agreement'? [2'es ❑No :� <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No 4 y 1 <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 [ No <br /> n <br /> ,�- APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 1° `� `' v (Continue on Back) <br />