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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 /> - r <br /> Ct�" S 0."'4 0.r 7e t c r4., CI Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 7 7 69 CL -r(V.Joay LC,, )tr o�C LJ ( Variance(# ) <br /> HOME PHONE SELL PHONE 7 E-MAIL ADDRESS <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> )=NT NAME CONTRACTOR E <br /> 1v1 S ��C'/ �• S �„.� �� �❑Site Plan including location <br /> AGENT ADDRESS CONTRA OR ADDRESS of well/septic <br /> (City.State,Zip) Vb(SIt4e1. 1 ❑Setbacks <br /> PHONE PHONE <br /> 0. `�I S0 8 ❑Site Plan approval from <br /> (0021--)S'-g)( 0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> LA',t)„(o\'-)a Q. ,i,a61.COM ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBE : CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> El <br /> PARCEL ] (( frontage drawn to scale. <br /> NUMBER C-1l� _.SO 5,0 I _L? R I ocr8 k x_0000 • 71 0•`{8"� <br /> TOWNSF{IP; SECTION: <br /> QtAC ,/: ,/4,/_ 0 Driveway permits <br /> ADDRESS: q�1/ \( (state,county,town) <br /> "l 264)0 ertrtiuJoo& Lt1 . VC2.f C_ LJ 1 ❑ ry p <br /> CSM: LOT SUBDIVISION t BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION - <br /> PROD T DESCRIPTION: 1` <br /> �( 0--> + Al 4 S-�-LJ,'e 4 .`ri, gccl a , <br /> OThis project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. 5_ Tt t }- <br /> SANITARY SERVICE: PERMIT NUMBER: a <br /> EWER JEPTIC t °` <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) z , =` <br /> AREA TO NEAREST SQUARE FOOT: : s <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r� . # , <br /> BASEMENT 1ST FLOOR: r ' ' { �., , <br /> 7 17 S? F • ,, TOTAL SQUARE FOOTAGE j -` ,, <br /> 2ND FLOOR: 3RD FLOOR: e sib -7 -f - -,,� <br /> I `"1 g- ,xr .c am' :14 <br /> ESTIMATED CONSTRUCTION COST: g� , <br /> (Please round to nearest dollar) "♦ ♦ ♦ "♦ '♦ '♦ $ r 0 �� t r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes X o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes go <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ON <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 r Jo DDon't know <br /> 7. Is this to correct a violation? Eyes ON o <br /> 7 APPLICATI MUST BE SIGNED <br /> Conti n Back) ♦ —► —► <br /> 645-772(4/08) <br /> c IL5 ....-- <br />