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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER T PROVIDE <br /> fa,+x3 /Vb I f i oo+ Zoning s`CUP;D ESS (Number,Stree),City, tale Zip) <br /> I � e /4r c 1 le:, /J4 /iv �y Deed Restriction; CSM <br /> -/ �/ fl CL �7 �'�, Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ite Plan drawn to scale <br /> AGENT INFORMATION l CONTRACTOR INFORMATION and includes dimensions <br /> AGEN ME 1 CON A,TOR NAME i <br /> k1/4 D an �� J C'`eo• �,fol,sos e,.�. ❑ Site in ding location <br /> AGENT ADDRESS CONT CTO DRESS ofwell/s •op,/b/ I P 4svo he-. /7D a s 7," ar ,/� <br /> (City, e,Zip) (City, te,Zip) Cks <br /> u, O. ,2 L �idJ 9 / G.7�' ,�3s�3 <br /> PHONE PHONE ❑ Site P n pproval from <br /> '7 7D'0,j�J`~ �`15_?7e):0 appl. a township. <br /> E-MAI ADDRESS® �' � E-M LADD SSA <br /> ADD l J6' ,e,i do . eo-�f �Lco %a,, i[,r:/�a-.zcs loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CUR NT NING: ACREAGE: P P y <br /> ❑ ex c� n frontage drawn to scale. <br /> NUMBER d��C► da 3�u� �� !,�f. <br /> TOWNSHIP: /J/ f SECTION: <br /> --7- yr `4 0 4., a q 1�4. 1�1�: rIV @Wa ermits <br /> ADDRESS: (s o ty,town) I ` <br /> ( ��, moo, ���.e • 4.6,�� e 4,� <br /> Sanitary , <br /> permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public <br /> PROPOSED PROJECT INFORMATION T'' <br /> n <br /> PROJECT DESCRIPTION: �_ g; � <br /> '/a?�.s6 x l� �a f o S c a� U ..�S zonir D _ Q .: <br /> This project is a new buildin or structure. <br /> g ,Permitted Use? y <br /> Ell This project is an addition/alteration to an existing building or structure. .- <br /> SANITARY SERVICE: PERMIT NUMBER: " <br /> SEWER 46EPTIC (no ���° • <br /> HEIGHT IN FEET: �7n �.,/i NUMBER OF STORIES: (Not including basement) 'i <br /> c�7A / � �ti'� r0e'J •a•€i Bin ' <br /> %/ + . st a e ae �,,. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) i t °' <br /> BASEMENT: 1ST FLOOR: 1. <br /> �— /I t� 4, TOTAL SQUARE FOOTAGE: j k •+ + <br /> 2ND FLOOR: 3RD FLOOR: g€ s sr / <br /> S`-5-;%7?- 's a ie d=. �in •8 <br /> kl.ESTIMATED CONSTRUCTION COST: and,„vl�l l o,e a• <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ Sam <br /> I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes Et‹. ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑N <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 one) <br /> 6. Is a location survey required? (see reverse) ❑Yes Ei:!;o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ♦ -* <br /> 545-112(4/08) <br />