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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 /> t'/t//9 1/A/. C, VI/0Z F <br /> ❑ Zoning Status; CUP; <br /> OWNER A DRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 70 ./ // y P 61,52_,c/ - W1— r3 5--29 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> a, -, `/ —S/) , o, -„or - 4-/SO ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> h,RT,TE /P,(.76,-/ 1,4,51g7`,7-F Lve/11. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Seht Of7"7E /f ,/9 $ 6 ' 7`7E /S , <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> L .5z- 1/,51L-f ' - 5-J7',/ L}- I/f/(E ti,...-5 S`37/./ <br /> PHONE PHONE ❑ Site Plan approval from <br /> .0'i- — 9fsr-7.2-0'7 a�'_ 9 'S- - 72 a 7 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ <br /> PARCEL dal A- _( frontage drawn to scale. <br /> NU D�'Z?Z- $OOD Z <br /> TOWNSHIP: SECTION: <br /> /21 7i/_F 1/4. 1/1/4. ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 7Ua/ 1-71w y I ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION sr R , <br /> PROJECT DESCRIPTION: <br /> yr P,So �:AQN� .St,7ll„elN& 9 1�DS IH t <br /> i <br /> ❑This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: CI Rural ress <br /> nSEWER SEPTIC ew/ ; ) 1 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 20 Q we3 a ..i,i(e3 <br /> nf <br /> AREA TO NEAREST SQUARE FOOT: D ''' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ( <br /> BASEMENT: 1ST FLOOR: M } N ; * <br /> 1`U X c-a ' 4, TOTAL SQUARE FOOTAGE: ,, A' ( .s„,-.1 C'tst1i ar nce, <br /> 2ND FLOOR: 3RD FLOOR: <br /> Gdd El goratocatkil Sury <br /> ESTIMATED CONSTRUCTION COST: Ate” <br /> (Please round to nearest dollar) -+ ♦ "♦ ♦ ♦ '* $ / 7 7 i.5- e and 81 v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®1Vo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 2 N ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ErNo <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? Eyes allo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) <br />