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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 /> FU ''PA'1 1C*Olt.CE%%5) ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> �31p5 pooOER T SUIT' R►A�E 1 S. Variance Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 7/12'2e35 12.-Z83E- ? ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> DAB le,06)11_EcR -81111 CA5 1.PcME 5 VC-.. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> `115" 1,1), 0)1:1 Si '715 u0. MI* Sr. <br /> (City,State,Zip) (City,State,Zip) . Setbacks <br /> AI 06. 535990 �ttJ ktE,uu1S. S-gc7 <br /> PHONE PHONE ❑ Site Plan approval from <br /> w8 3 Hc00% 60 3-,F3357"60ri b applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 1)1Pl{) 01n1t1 --01131061}4ofES.p 541E ❑ 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 /> ❑ <br /> NUMBER 0812 20296-002 ft-2') 4-31 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 'rilevi =t 20E .1/4: %IA: 1�i3O ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 522 LAP 'R0 . t9rwil ..dt'S, 53559 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> 1 (public,private) <br /> PROPOSED PROJECT INFORMATION l�- <br /> PROJECT DESCRIPTION: �F���� / <br /> i V )AL{10( g ifkiliCt <br /> ®This project is a new building or structure. l use? <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ural ear/ X <br /> nSEWER SEPTIC j(new/existing) it-V <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement) <br /> 2) ° 0W «;t atr ` <br /> n eland"(attacment) <br /> AREA TO NEAREST SQUARE FOOT: 5,.• ,, <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: g � • 't;'. <br /> 2'19.2_ 3393 ,, TOTAL SQUARE FOOTAGE: j ( ,, '-r`® $ ref <br /> �V fill( r <br /> 2ND FLOOR: 3RD FLOOR: <br /> 14 tJA 55 b5 <br /> ESTIMATED CONSTRUCTION COST: $ �/ , t '/ivalla0 <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ ". $ )" L/C�'v <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? ❑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 /> r <br /> tAr ,1� APPLICATION MUST BE SIGNED <br /> Vl (Continue on Back) —► <br /> 545-112(4/08) <br />