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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 /> SC-tlA'-e.a� STD C,1-C k z—LC 0 Zoning Status;CUP; <br /> OxuNERADDRESS (Number,Street,City,Stag,Zip) Deed Restriction; CSM <br /> 2ic (°7-030 S in(�r.Qdi-c-� 0 t �= S S.-.Z., 2 -0305 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> c--... (v�33"VI SY t. .-- 0 eS'6 -m ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME 1• <br /> I/i,-,,-).0 e.. W ' RS [o.� CcM-s c � ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ?o 3n v?o_zoS foie S,I,,w rke- iC -rA . <br /> (City,State, P (City,State,Zip) ❑ Setbacks <br /> R.{- k . C-49?-C)305 yl':Ja��--, <br /> wT S�z <br /> PHONE PHONE ❑ Site Plan approval from <br /> (.20 -3._. _ -n 5'-y L.20%--- 53c—°)(o6) applicable township. <br /> E-MAILADDRESS E-MAILADDRESS /ieP-Q AI—' <br /> j''r- t'I-i S to . �. -y",,,A,c ' (�,,r,e s a e..�or pj t c s to III- <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER L9 Cr0.3--kC -`)yam. C - Z 3,'-?t/ -II frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> "G. 6 S,�R__1 cif , S.- '/4: WA: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> Cp S I'-r _C-L1. 1r- ��.t-clI ill ce dcAl� - (--s-- s 3s--zi <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION xf tl. , , <br /> PROJECT D SCRIPTION: <br /> ®This project is a new building or structure. 4 <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: '.D.--t. PERMIT NUMBER: +• <br /> FISEWER F1SEPTIC g <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) n'; <br /> „6d a i x ,` <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) :. q <br /> BASEMENT: 1ST FLOOR: ,,,+ „ + + a ` ;, <br /> ._� 3-9 _(D j TOTAL SQUARE FOOTAGE: + k + + '-€+ + l' <br /> 2ND FLOOR: 3RD FLOOR: � �U 4 �-�' <br /> �+ , <br /> ESTIMATED CONSTRUCTION COST: w +� ' t, ®+,a s <br /> (Please round to nearest dollar) "� - • � � �, <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 LJ No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? fYes p 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 /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -♦ ■ -► <br />