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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 /> C-"I'D L CoL4iDoiNAcIA. c ❑ Zoning Status;CUP; <br /> OWNERADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> CCIPC \ A CQ , c�t L Cj fa' Variance(# ) <br /> HOM PHONE ,_ CELL PHONE 1 E-MAIL ADDRE <br /> _Ago -3`(.- .111% ❑ Site Plan drawn to scale <br /> . AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAM CONTRACTOR��NAME <br /> �� I <br /> .. 1�iin 1,��Pio� 1k1 OelnL"r Jc. t''1©U1�leS • Site Plan including location <br /> AGE T ADDRESS CONTRACTOR ADDRESS "F•_ 7 of well/septic <br /> P.C) ( jc lQ ati*fiteysiggaiRige. <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE • PHONE - t„,,,,,,,,..,_<,(b T❑ Site Plan approval from <br /> (C�©�) $b C t° applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: C RENT ZONING: ACREAGE: <br /> ❑ PARCEL 4. /0 CD\\_1�.1-:1- a f1 _ a�, frontage drawn to scale. <br /> NUMBER t,J-t�o `� <br /> TOWNSHIP: (� SECTION: <br /> T®U.)V\ OT- ei�QS0-V-1.p ob1 e__.. 1/: 1ve. 1/41/4: ❑ Driveway permits <br /> ADDRESS: t ^& (state,county,town) <br /> `)1` R� v D ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> IN..))e i/3 ►10Uu >�/ \- OV C�ct C-c , .Newt,: <br /> . ..►' This project is a new building or structure. <br /> • This project is an addition/alteration to an existing building or structure. <br /> �Ittecl <br /> _ ( Address <br /> SANITARY SERVICE: PERMIT NUMBER: f 1 ` <br /> (SEWER [EPTIC 13-"3,C.‘ ogac3 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> E 4 <br /> aCa. J QC�.) cM C We � apt r <br /> AREA TO NEAREST SQUARE FOOT: Sh4selame <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) a E .$., $ . <br /> BASEMENT: � 1ST FLOOR:�� <br /> e%. <br /> j TOTAL SQUARE FOOTAGE: s.�. a diSiti 'a ce <br /> 2ND FLOOR: 3RD FLOOR: . :* 11 <br /> X.?: - lj uJ U- *1 e Location Survey <br /> ESTIMATED CONSTRUCTION COST: anE " ,. ,.,s• ,. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 350` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes E'IVo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes V o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes V No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#1-5-4-0 ) (leav 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 I 1I i <br /> 46(). APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />