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ZONING PERMIT APPLICATION www.counryofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME J/ LTII L—. � ❑ Zoning Status; CUP; <br /> OWNEDDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM/ <br /> $', ��E C uc��,Z � ✓;i{ i� 'Ik&R iisl 5 3S 9 k Variance(# ) <br /> ME PHONE CELL PHONE E-MAILA DRESS <br /> 0 . 30 / <br /> El Site Plan drawn to scale <br /> AGENT INFORMATION �CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> I <br /> (City,State,Zip) (City,star`,zip) ❑ Setbacks <br /> PHONE PHONE El Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS <br /> E-MAIL <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER °q1° 2R'2hJ$ Z �^ 2 d 2_.S- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> • ,r\cQSo r- 2°I 1/4: %IA: ID Driveway permits <br /> ADDRESS: (state,county,town) <br /> 413 88 59 ,4 D t c� Or ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1 s� (public,private) <br /> PROPOSED PROJECT INFORMATION ' <br /> PROJECT DESCRIPTION: "lF � <br /> 6-,c4) l� S 7 v.�r�G'� ......./-1 /) ° Istria <br /> 2This project is a new building or structure. o ' * H <br /> ❑This project is an addition/alteration to an existing building or structure. & <br /> SANITARY SERVICE: PERMIT NUMBER: Cr, � � <br /> RSEWER nSEPTIC y <br /> a , <br /> HEIGHT IN FEET: s I_3 it NUMBER OF STORIES: (Not including basement) � � �t y . <br /> AREA TO NEAREST SQUARE FOOT: <br /> d chment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,k/ <br /> BASEMENT: 1ST FLOOR: 0-1--11:S.2,7� , * +I� ' <br /> j TOTAL SQUARE FOOTAGE: 1 .. '� �� a • nom,in. <br /> 2ND FLOOR: 3RD FLOOR: / <br /> (O <br /> I 0 Rte ,.. <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) y.,,, <br /> 1. The property is within 300 feet of a stream or 100 feet from a pond or lake? ['Yes �No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? ❑Yes ►� No ['Don't know <br /> 3. Have you talked with the township about your proj ct and are they in agreement'? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this pr perty in the past 5 years? ❑Yes N N <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes El No ❑Don't know <br /> 7. Is this to correct a violation? El Yes No <br /> AT BE SIGNED <br /> (Continue PPLICATION on BackMUS) ♦ —► <br /> 545-112(4/08) <br />