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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROW/7E <br /> OWNER NAME ' <br /> 7 i,-,72 1e <br /> Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Stat Zip) �� Deed Restriction; CSM' <br /> / <br /> .5-ea zoC.../z/v 2S 7k-4-/L 14 i -/Zes 4_r `"' r3 'y Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS i 2/3 <br /> fa Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions i/� <br /> AGENT NAME CONTRACTOR NAME /f//�� , / 7` v <br /> A,Ai i '2`--f/ LeL To, �yrr_�.j .:. g locati <br /> AGENT ADDRESS CONTRACTOR ADDRESS • ell/septic / ` <br /> vv- cCzv/fLJ c /- / Lam/ <br /> (City,State,Zip) (City,State,/Ziipp) 2s-��-/�' %d Setbacks 3 6 �B <br /> PHONE 4141�#4.4.e- !� cr.. <br /> PHONE Site Plan approval from .. <br /> /v 02- f —e/U9_3 applicable township. //f___ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Er 4 Ze j ; / 0 A f/14 7 '001-1. Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE I <br /> ONING: ACREAGE: E-Elevation of property <br /> ❑ NUMBER D0/Z09 3 0 c g OS- " op 7/5L frontage drawn to scale. /- <br /> TOWNSHIP: SECTI Ni / 0 <br /> •4/L`0/4/4 (� '/4: /V Ni l: '/4/4; it/ Driveway permit <br /> ADDRESS: (state,county own <br /> S C.__. <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> pe �� S <br /> • S 'YL/n/cL E 4 2 0 (publi �;lit <br /> PROPOSED PROJECT INFORMATION ',1ST' F <br /> AILTIEW: 1 <br /> 1 ''-- 1,: ? --/",,-- r' ''it .....,, <br /> PROJECT DESCRIPTION <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: ROU '' ++iC .. . s . <br /> SEWER SEPTIC €� 9 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: $ �):." <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) j <br /> BASEMENT 1ST FLOOR: �� � • �� �� <br /> 2�4 4, TOTAL SQUARE FOOTAGE: + � 4:10 i <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2- 0:9- A �/ <br /> ESTIMATED CONSTRUCTION COST: ♦ ' 4 k of e= iV jC <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ $ 0:1/4? , tiq �� � � <br /> 1 <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 ❑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? 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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? Dyes ❑No <br /> t , / i :—•iii <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ —► <br />