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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME <br /> M A ie.& d/ AA i 6- et ...-- 1- P/2-1 .s/ 420 wt- ❑ Zoning Status; CUP; <br /> OWNERADDRE SS umber,Streeet,City,State,Zip) lj Deed Restriction; CSM <br /> -_ 'be / r �04;7- <br /> " j&-7 012-466,s0 �� -S Variance(# <br /> )HOM CELL PHONE <br /> E-MAIL ADDRESS <br /> "013 S - 47g ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAi, CONTRACTOR NAME <br /> J z i1.. G�t N &0 J-i c.l eo,t) ,- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACCT"OR�RESS ��y of well/septic <br /> State,Zip) A3b ^/�e . .�5 }�"' <br /> (City, p) (Cit ,State,Zip) 242 ❑ Setbacks <br /> PHONE a PHONE /6.1. 4.....] Site Plan approval from <br /> / 4 . g ,�7�, o g applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> • <br /> R- C , .0., ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/iaccessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT NIN : ACREAGE: ❑ Elevation of property <br /> El NUMBER /I -'1z-c -3=D O• iiI74 frontage drawn to scale. <br /> TOW SHIP: SECTION: <br /> neap-krk Sp( j v Oi S 1/4: ,�4,�4: ❑ Driveway permits <br /> ADDRESS: 1 i r (state,county,town) <br /> c 1 c C t xs v tt W c. ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION " ,STA REVIEW <br /> PROJECT DESCRIPTION: <br /> Or <br /> -0 5 rk k)6-i 0,3 — 5/ 46'1— ,$17 ��� C�� Duct <br /> . This project is a new building or structure. <br /> PiPerTt'rttded,ths <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVIC • PERMIT NUMBER: ti I rem 4 <br /> - SEWER nsEPTIC tew/e <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: $Ili Sll (attachment) <br /> fit) <br /> i <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Ft E <br /> �• <br /> BASEMENT: I { i 1ST FLOOR: ,) s5.---/ <br /> TOTAL SQUARE FOOTAGE: j ��?IeSt � �r 9?Fti <br /> 2ND FL OR: �� 3RD FLOOR: �' <br /> a . <br /> ` ' L y fl �700-i%n ve <br /> ESTIMATED CONSTRUCTION COST: BvB ! <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 330 0 00 <br /> 1. The property is within 300 feet of a stream or 000 feet from a pond or lake' El< ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑N <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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> 6 1. 1 ` n APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -♦ <br />