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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N E <br /> I,lerry/G w P4 ld oning Status; CUP; <br /> OWNERADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3$9 -rA Ir Oa,t' rc/ Varia ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 110 5'97/b Il4P SPctn!la-i( a 0 ah•• .Ccri1 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sit an including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip racks <br /> PHONE PHONE ❑ Site - - -••.roval from <br /> appli . • : township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS . <br /> [ r°plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) EI tlOn of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 26 5 t s <br /> ❑ PARCEL /� `/ �/ q �A n ntage drawn to scale. <br /> NUMBER :/0)7 C71Z-23Y- //50-O 4 2&) OCP/?Ez- "Oba—OfZ6Z <br /> TOWNSHIP: SECTION: <br /> beer-it t Id ,23-7-1z %: SE %4%: ❑ Drive ay mits <br /> V ADDRESS: <br /> (sta unty,town) <br /> 3.39 -Pk 4—oX lc r a beet/ ,ie{d_ 535 51 ❑ Sanita■ permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1 OAS G C> / (p • ' , rivate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> ckoci /ack e..1 Aou54- 80x/6 <br /> . ❑This project is a new building or structure. <br /> t <br /> 2'This project is an addition/alteration to an existing building or structure. ,,x Z <br /> SANITARY SERVICE: PERMIT NUMBE•. x`axe <br /> N A :. wy <br /> D SEWER �� SEPTIC =v� � <br /> HEIGHT IN FEET: NUMBER OF TORIES: (Not including basement) ;11 <br /> AREA TO NEAREST SQUARE FOOT: 1 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) '' k_k. i-: <br /> BASEMENT: 1ST FLOOR-, <br /> j TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: Or£ <br /> 4_ <br /> ESTIMATED CONSTRUCTION COST: (1 / CO(Please round to nearest dollar) '-'∎ -'∎ ♦ -"∎ S C r' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes !Q No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes LNo ❑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 icii No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank is lo <br /> 6. Is a location survey required? (see reverse) ❑Yes A! o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes • <br /> APPLICATION MUST BE SIGNED <br /> 545-1120108) <br /> (Continue on Back) -► -+ <br />