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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUS OMER TO PROVIDE <br /> OWNER NAME <br /> JoLi'■ Lr <br /> OWNER ADDRESS (Num Street, ity,State,Zip) II O ing Status;CUP; <br /> 1 1\ `` � ' 1 D ed Restriction; CSM <br /> q �— co, 2_ SD, kA.J L A S 3 > V ri ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> U, z iz-I - ❑ Sit Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION an includes dimensions <br /> AGENT NAME RAC NR NAME .(� , <br /> AGENT ADDRESS <br /> vie_ v& A'� 11 —�% �'❑ Plan including location <br /> CONTRACTOR ADDRES6 of ell/septic <br /> ` <br /> (City,State,Zip) (City,State,Zip) ` etbacks <br /> PHONE 51\34` r w ,_-3,_ 1 <br /> PHONE ❑ Si PI approval from <br /> (, 0 8 ?-1) 6 - a-0 S a ' able township. <br /> E-MAIL ADDRESS E-MMRLS <br /> tL ADDRES�ifL 0.44,l(tr r` 1 °i`l t loor plans to s e <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONIN ACREAGE: ❑ Elevatio of property <br /> El NUMBER (0'V -- 0 P -�r��O ^ N fronts a drawn scale. <br /> TOWNSHIP: SECTI : 1 , � 1 <br /> \kh V\-- 1/4. !V J 1/1/S krj ❑ Drivew permits <br /> ADDRESS: (sta ,county,t. • ) <br /> csM: , OT ❑ Sanitary dermas <br /> no <br /> SUBDIVISION BLOCK/LOT <br /> #. ' (publi,,private) <br /> iti PROPOSED PROJECT INFORMATION <br /> ,1' AP*R 1� <br /> PROJECT DESCRIPTION: Q Q � � � <br /> 7 s ` a c�\Jam, / ,i� th� <br /> f rs" <br /> ❑This project is a new building or structure. - <br /> Prin-t �Se� <br /> his project is an addition/ eration to an existing building or stru ur . ; °"" r„ <br /> r 0 Ru rc <br /> SANITARY SERVICE: PERMIT NUMBER: ^ � r �, �� <br /> SEWER EPTIC 'v / 4, y <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not in uding basement) <br /> 11 ; <br /> AREA TO NEAREST SQUARE FOOT: # Ea '° z.4. <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) -Al <br /> BASEMENT: 1ST FLOOR: EOSt; ,• s tt <br /> 7 al— j TOTAL SQUARE FOOTAGE: j WC)+ •- 4. . Ce, <br /> 2ND FLOOR: x+ <br /> 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: 0 iW V <br /> (Please round to nearest dollar) ♦ '� '♦ ♦ ♦ ♦ t� (� l� , )IBS v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes • o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Crib • ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes Ur o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes in <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan none) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? 111 Yes No <br /> . S Li() APPLICATION APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -■ <br />