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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> - <br /> -6 5-0-35`''"` FJ"`I- MZoning Status;CUP; +/ <br /> / OWNER 4CcTH <br /> �� ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> ! M 7 f Variance <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 64-7 -3 2. Ai` i Site Plan drawn to scale <br /> AGENT INFORMATION ( CONTRACTOR INFORMATION and it ; •'.1,- sion <br /> AGENT NAME CONTRACTOR NAME Itupw- <br /> 4IDbS01--► kJ:Lainx- 40 j. ..k.7 II Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> (�"~e P` 2 <br /> Ify,Slate,tip) (C' State,Zip) tbackS /(� <br /> PHONE PHONE `Site Plan approval from <br /> c 2-4— 3t ct applicable townshipiv4 <br /> E-MAIL ADDRESS E-MAILADDRESS r - C <br /> ∎�-9 ( „�-e,-r�pM ►.4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARCEL NUMBER: CURRENT ZONING: ACREAGE: p perty <br /> IDPARCEL /by 0`_01 I_^�{- A-1 CE/c) rM. ,,r frontage drawn to scale. <br /> NUMBER / 7,J \ `C <br /> TOWNSHIP- SECTION:" its <br /> 0r 1J- .so 14: Ne '/4'/: '"go•. - town) <br /> ADD S: — (" - - <br /> 9 c ` J fiY-- F i Santa ermits $(14 <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pU private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> (r7 t c ism <br /> se <br /> . This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. 4 <br /> SANITARY SERVICE: PERMIT NUM R: a 5-s - <br /> [SEWER SEPTIC /C C Lit4,1..,./yk <br /> b <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not induding basement) <br /> ! s ain/ _ <br /> AREA TO NEAREST SQUARE FOOT: t) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` F i-= . <br /> BASEMENT 1ST FLOOR: <br /> © 4 TOTAL SQUARE FOOTAGE: 4 <br /> 2ND FLOOR 3RD FLOOR: ¢ � <br /> ii L . ,t <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ � l e <br /> (Please round to nearest dollar) $ S � oo >t? F •_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes JNo ID Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYesNo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 0 Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes '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) D Yes 121No ❑Don't know <br /> 7. Is this to correct a violation? El Yes RI No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -+ <br />