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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW R WAME <br /> c�S��„►� <br /> oning Status;CUP; <br /> OWNER DDRESS (N ber, treet,Cit ,State,Zip) Deed Restriction; CSM <br /> ��-6 P°'l Y r S o i,-. Variance(# ) <br /> H ME PHONE CELL PHONE E-MAIL ADDRESS <br /> 34 -n°4—) We 9 't_ �no� Ce [� Plan drawn to scale <br /> AGENT INFORMATION �CONTRACTOR INFORMATION and includes dimensions <br /> AGENT INAME CONTRACTOR NAME <br /> WC)-� CO ic)S ❑ Sit Including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of eptic <br /> (City,State,Zip) (City,State,Zip) [backs <br /> PHONE PHONE El Site PI pproval from <br /> applic township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> FI r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ation of property <br /> PARENT PARCEL NUMBER: CURRENT, LI1: ACREAGE: P P Y <br /> PARCEL KK frontage drawn to scale. <br /> NUMBER p�I -)-GL/ n 15 <br /> TOW IP: CTIOf <br /> l- v� '/e:S '/a'/a: riv W its <br /> ADDRESS:q)-1 G (Stat/ nty,tow <br /> I - Lit' [L8a ' permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT /4111D, vate) ,fir <br /> PROPOSED PROJECT INFORMATION F +� <br /> PROJECT DESCRIPTION: <br /> Car � �stt <br /> ❑This project is a new building or structure. s° F ' <br /> it*O9liel <br /> ❑ ;0; <br /> This project is an addition/alteration to an existing building or structure. �� <br /> SANITARY SERVICE: PERMIT NUMBER: ,, } 5-M <br /> (ER nSEPTIC rV t� ° ,,,-: .,,,,, <br /> HEIGHT IN FEET: NUMBER OF STOR S (Not including basement) yf's. <br /> yi <br /> AREA TO NEAREST SQUARE FOOT: (qt Ch <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �,` <br /> BASEMENT: 1ST unfinished a s s t1c�t�1t <br /> / 6F, 4, TOTAL SQUARE FOOTAGE: + �� <br /> 2ND FLOOR: 3RD FLOOR: --7 6 3 'w . E <br /> / W 0 0.3 Stint <br /> ESTIMATED CONSTRUCTION COST: „ .i ; O <br /> (Please round to nearest dollar) ♦ ..+ ♦ ♦ ..+ ♦ S, Z a , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No El 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 ❑N <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 /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ —► <br /> 545-112(4/08) <br />