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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 /> yZoning Status; CUP;O ADD ESS (Number,Street,city,�tatebZip) Deed Restriction; CSM )( <br /> (� G T Y G Variance . _ ) <br /> HOME PHONE CELL PHONE <br /> E-MAIL ADDRPSS <br /> i C64) LO C ` `� S C, n L1 a /40 t mel . c a 44 <br /> � <br /> iAte Plan drawn to scale ,- 9 <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions a '�` <br /> AGENTS NAME CONTRACTOR NAME <br /> S c a t S 6 w p`( (/e 5(1 �l v'fd'n CO t ! rl Site Plan including locatio l ► A , <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic _ <br /> PQ nay Cf36'aao 21 <br /> ( <br /> 4/00 <br /> City,State,Zip) V*ro,ii l � <br /> State,Zip) S-3 S,5 3 Setbacks <br /> PHONE PHONE Site Plan approval from <br /> C 6$ c€1 " 5- �1 7,019 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ver0Iv( Q6.(esty6U;idr`'+ ,,co W) EfFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.d, I - . " ) <br /> PARENT PARCEL NUMBER: CURRENT ZON ACREAGE: L'Elevation of property <br /> PARCEL r� / plc frontage drawn to scale. <br /> El NUMBER O'.f VSO 7-PI )-1690 4 �4 I a �C U 0 0 0 g <br /> TOWNSHIP: SECT 4: <br /> To LJ n d- - Pr', in rose / i 1/4: /v '/1/4: /V/= Drivew.z.•- 4 its <br /> ADD <br /> g�SS: (state count own) <br /> `� e06 1 ' P6 1:1 Sanita .- •-'ts <br /> CSM: LOT / SUBDIVISION BLOCK/LOT <br /> S- 74 �_ (pub,c, private <br /> PROPOSED PROJECT INFORMATION <br /> &TAFI���/IE1� <br /> PR fJECT DESCRIPT ON: 1 / / I <br /> SC, ( -I .E f �p '/C1 ' V e {ti�C C-�' ' in <br /> C G'1' S g e i0 U r ^% zoning 11 is 4-- , <br /> . E This project is a new building or structure. / ' v ■vCS443e- r4 Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: y *•-t <br /> oe � <br /> nSEWER nSEPTIC (6,1':1-' ' } % / <br /> HEIGHT IN FEET: r 11 NUMBER OF STORIES: (Not including basement) '' ©O <br /> AREA TO NEAREST SQUARE FOOT: / r # '706/ <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FL 915:11:2-- / <br /> 3 a j TOTAL SQUARE FOOTAGE: j �! *mss, / <br /> filling ' 4 0 / <br /> 2ND FLOOR: 3RD FLOOR: 3 CI <br /> ESTIMATED CONSTRUCTION COST: 2 c, a • <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ -9 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ❑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 E 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? Dyes .]No <br /> 1Th2 .2_ o., V APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -9 -+ <br />