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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 /> -611-NC (11C4 Vk\ s <br /> []'Zoning Status; CUP; <br /> OWNER ADDRESS I�Nuum r,Street,City ate,Zip) Deed Restriction; CSM <br /> 39 r9 1 U 1& pc i' (f)Dcl, (N).C-Va 5 3S—St Variance(# ) <br /> HOME PHONE CELtHONE E-MAIL ADDRESS <br /> 8 3- 1 7a -r n k r0 t-jS-R'e-� p Ste Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> JP C G 2 s j!rkl(on 14 Cr' V I On Oi\ [Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE / Ettite Plan approval from <br /> 6 68 6.5-8- 6-180 /(oc8 3a62frue applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 12-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 /> ❑ PARCEL / _) / 9 frontage drawn to scale. <br /> NUMBER '� OlOI�-�IoI�V�I`�O �� I, I / <br /> TOWNSHIP SECTION: <br /> /0 LAM of Venn /& 1/a: /Vf 1/4%: rtf£ ❑ Driveway permits <br /> (state,county,town)lYktviney p aOO (144& t O <br /> l 5���� <br /> El Sanitary permits <br /> CSM: LOT 8tiBelY4610(4> .BLOCK/LOT <br /> /D5 (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> Sir �� <br /> PROJECT DESCRIPTION: y /i <br /> t311Y 61 L-X eS I{ }plc (,,,2A w 5 cap- / d 'a:'2:-4 ' <br /> . ow This project is a new building or structure. P,��U� rV <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural 'r ": <br /> ri SEWER SEPTIC ' gi <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 56+- 1-1/1(), PiAr k_ 1 Pad (-) L -j*1# atnt <br /> AREA TO NEAREST SQUARE FOOT: $ht r f} <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) % Osion <br /> LI 4roSt>~3I ', 4I <br /> BASEMENT: 1ST FLOOR: '�;. <br /> j TOTAL SQUARE FOOTAGE: ,l /�/, • € rban� <br /> 2ND FLOOR: 3RD FLOOR: film 'h <br /> ''' ..4 . Zierr <br /> ESTIMATED CONSTRUCTION COST: fr <br /> (Please round to nearest dollar) ♦ ♦ "♦ ♦ ♦ ♦ /ti/ 785:0— r nd 9Vd � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes f to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 01. No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? laYes ❑No <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 0 Don't know <br /> 7. Is this to correct a violation? ❑Yes ryiNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />