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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> S4- L R k l `cam ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,St t,City,State,Zip) \ Deed Restriction; CSM <br /> tL o Lan �c.r-� j/o,k) Ln t,✓a,u nc� tJ ) S3 S 1 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-M//AI�ILADDRESS <br /> 64) dos 7-2 2- • > sf Q1'1 `vt63 @-a "~4r`I • c°"1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 2 l■ockg Cogs c-k WY. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRAII TOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> I__, PARCEL Q 96 63-972D -0 2- frontage drawn to scale. <br /> NUMBER 9 ,1 �� <br /> TOWNSHIP: SECTION: <br /> Vi a.nn a '/o: '/e'/o: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 2 LcY►le,,ito (public,private) <br /> PROPOSED PROJECT INFORMATION Ak ' F <br /> PROJECT DESCRIPTION: ?4 :''''-"'"-- � // <br /> U (Di. <br /> . [f This project is a new building or structure. catoudiii6 Use? <br /> ❑This project is an addition/alteration to an existing building or structure. � <br /> , <br /> SANITARY SERVICE: PERMIT NUMBER: - al� ,: <br /> n` N. ', <br /> SEWER nSEPTIC -Sr 26/...r--O 2S-r- ( o /8 x <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> r Sh nd (attachmeet) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> B 18NT: 1S RXV: ,.o ti +fllttFE?( t�IIts) <br /> TOTAL SQUARE FOOTAGE: hopes • r-°s <br /> 2ND FLOOR: 3RD FLOOR: <br /> (36L/ <br /> ESTIMATED CONSTRUCTION COST: � RD�tSW� Survey <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ "♦ ♦ $ 6,(S.--(P O � � 18Q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? El Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes E1 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Dyes ❑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 riFtNo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> C° <br /> 1"1,,,,'\ J APPLICATION MUST BE SIGNED <br /> `" (Continue on Back) ♦ ♦ -0 <br /> 545-112(4/08) ��. J• - - <br /> / <br /> i <br />