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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNS NAME <br /> `� v�e_71 )011.\1_k k < " , it ❑ Zoning Status; CUP; <br /> OWN RADDRESS (Number,Street,City,State,Zip) j <br /> I (8 G O 6 <br /> 3 �C l 4--OY\ ( 1 S Eti Deed Restriction; CSM <br /> 1 �' S [_i �l 6 ) I ( Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS A + 6-4-40— <br /> 170 �L"! +I . [� l._ /ens ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME �� ( CONTRACTOR NAM <br /> ` ty iih 6- -L-C41 -/z-i 1,66_ lMi ❑ Site Plan including location <br /> AG NT ADDRESS 4v; CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Y^,1 P-• tSo' ." s 3 7/3 <br /> PHONE l PHONE El Site Plan approval from <br /> 0 . /1G <br /> / , L t J d applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 2 [ • a-i ,1 o 64 ,q,+ e.-...--- ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ <br /> PARCEL ! fronts a drawn to scale. <br /> NUMBER ©61) •-292 /ZO0"3 r !, (D Co l S g <br /> TOWNSHIP: SECTION: <br /> pi.P a SA+ 7" Se,2 Al ..c .1/4: '/4'/4: ❑ Driveway permits <br /> (state, county,town) <br /> ADDRESS:)(11. [� (� /� � //, ++ `f <br /> I � ( `7c1 iy4- 1• S IL&5 4. 't�t ,,U.% 3-.7�r ❑ Sanitary permits <br /> CSM: LOT lCll SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> 1STAI*REVIEW <br /> PROJECT DESCRIPTION: <br /> ' E.-.0 c��W i t'Yl 1^n t r PO 0 L O Zoning Distr <br /> . 1,1 is project is a new building or structure. <br /> q Permitted Use <br /> ` This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVI E: PERMIT NUMBER: uT I 4 TTeSS <br /> SEWER nSEPTIC s 01 <br /> HEIGHT IN FE T: NUMBER OF STORIES: (Not including basement) <br /> Q Wetland/Floodplainl >, <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOO L TOTAL SQUARE FOOTAGE: � ce, <br /> 2ND FLOOR: 3RD FLOOR: Li iviC , , <br /> ESTIMATED CONSTRUCTION COST: / and a.,Location'n Survey_' ' <br /> :: <br /> (Please round to nearest dollar) "♦ ♦ ♦ ♦ ♦ ♦ �� a <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 E1 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? ❑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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> � U <br /> � o " APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />