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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME n � ��(f/, <br /> OWNER ADDRESS�/(NJmber��e ,State,Zi I�► oning Status; CUP; <br /> p) Deed Restriction, CSM <br /> �s �G1111/ OFIJ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,0 If a_ ,6(-a 2-73a' 1,1 /eon'il 61A CJ/1'I i p Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C'l/n 7 COlyjtjrj'0/1 Site Plan including location <br /> AGENT ADDRESS CONTRACTORADD ESS .f well/septic <br /> `-2 65 Ltt fd <br /> (City,State,Zip) (City,State,Zip) EirSetbacks <br /> L , - 7 3 <br /> PHONE PHONE I/ Site Plan a royal from <br /> Epp 5V— .4 la (�p -Pi -fa$3 applica township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS 1. - !. I�� Floor plans to scale <br /> u ..1I L'1 !�lA0 I 0 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PAR EL NUMBER: CURRENT ZONING: ACREAfpE: Elevation of property <br /> ❑ PARCEL 0747- ©G/,. '/� OR-IA I , ontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTI y�1 _ <br /> U141/11 Ul — 1/4: ' v '/4'/4: iDriveway permits <br /> state,county,town) <br /> ADDRESS: <br /> , e6 'r t\in rOv <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> (pu.lic,private) <br /> PROPOSED PROJECT INFORMATION 16:- <br /> ST i- <br /> � REVIEW <br /> PROJECT DESCRIPTION: <br /> \COO Irma vim) k 01.4 \I- '0 rc_ R , € !,ice y' <br /> • .This project is a new building or structure. € & ,�se?. <br /> p This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMI N BER: _ "• tress <br /> ■SEWER SEPTIC 0 L ~ 0 r it xisting)�'' f <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) f <br /> sS • ., i (a €m <br /> AREA TO NEAREST SQUARE FOOT: i <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 64 <br /> BASEMENT: 1ST FLOOR: �� Erosts • €r • 4, <br /> t----- ��!' ,, TOTAL SQUARE F••TAG : (slopes,+ € ,€ :' <br /> 2ND FLOOR: 3RD LO* a7,�j��• % - a;�� i <br /> i��� SSG�"- o""S','A 1 Qi',%. , o s.'^ ' <br /> ESTIMATED CONSTRUCTION COST: l'' �"` t <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 3 .0 pot) ,00 <br /> . 3 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes lo ❑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 /> No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ENo <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 .2 , a ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ,&No <br /> `�j 0 APPLICATION MUST BE SIGNED <br /> l-' (Continue on Back) ♦ -545-112(4/08) �/ 7_3 <br />