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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,, M� 1 n e . U `e Wing Status; CUP; <br /> gnu 3 EZ Numb r,Street, ty,State,Zir/ ii,e ,n Deed Restriction; CSM <br /> �// G l� ��� �GI� U C �dr , ��� Van ce(# ) <br /> HOME• ONE CELL PHONE E-MAIL ADDRESS <br /> I �r,�a 2 i ,� /, f j�5�7 /1//,/ / Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATIOA and includes dimensions <br /> AGENT NAME s'IT TRACTOR NAME V <br /> ❑ Site PI ' cluding location <br /> AGENT As•CESS CONTRACTOR ''DRESS of wel ptic <br /> (Ci y,State,Zip) (City,State,Zip) etbacks <br /> ,■P ONE PHONE ❑ Site Pla pproval from <br /> app. b 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: CURB TZ ING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER OC i/ I5/ q-9' ,X7 frontage drawn to scale. <br /> iiptSHIP: II i SECTION: ) <br /> '/4: '/4'/4: Driv ermits ,vC�'l` <br /> ADDRESS: (state,cou ty,town) <br /> �zES8 / t:�� low,,,-4—,� 60/ <br /> CSM: LOT SUBDIVI N BLOCK/LOT Sani- -rmits <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: AFF R IIW <br /> v <br /> . El This project is a new building or structure. <br /> RThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: . <br /> exa � <br /> 7 9""A4 e l/„. <br /> SEWER nSEPTIC (a , <br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not including basement) €% <br /> / / .0)14s eesplal <br /> 1 %,St for a 4' atta hmiiit <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .r „ � <br /> e ,s s os�.� 3 '�" <br /> BASEMENT:, 4 1ST FLOOR: 4 m <br /> /��/ <br /> /7,4 j, TOTAL SQUARE FOOTAGE: 4, °";e + y •' , ^`y'1/' <br /> 2NDFLOOR�� 3RDFL00R• ��3 e err � <br /> �# <br /> /7A4 <br /> Review _e s-rt:.11 '�iliit!P*.�",� <br /> ESTIMATED CONSTRUCTION COST: _. - ; ,t. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ` ��� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? tgYes ❑No ❑Don' no <br /> ----S <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? bYes ❑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 ❑No p Don't know <br /> 7. Is this to correct a violation? ['Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />