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ZONING PERMIT APPLICATION ►uuwww.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> s \O 1.L' - ❑ Zoning Status;CUP; <br /> O/W�NERADDR SS (Number,Street,City,Style,Zip) Deed Restriction; CSM <br /> aO 17 I A . U� pig;,- L S,��, �✓�' s s7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILAbDRESS <br /> A-'7 D-O .7� Q,,.,. ,, , 4 }. ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTnR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Snerr.A� �(4._sc-\.Q;� S t./N. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> S%t�� <br /> (City,State,Zip) (City,Statle,Zip) ❑ Setbacks <br /> PHONE PHONE <br /> ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL /�yy�� / / n /� frontage drawn to scale. <br /> NUMBER Vt�� ' Q"L _O6-571' c a .0 7% ( g <br /> TOWNSHIP: SECTION: <br /> s %-.).5 ';e /(5' .1/4: 1/1/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> °g 1 D" ,``� �� �P El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 7 <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: R v y <br /> ,This project is a new building or structure. 7 <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: RUB € •• <br /> SEWER SEPTIC N{ + <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: �` �� � <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> .i1® �trol • <br /> BASEMENT: 1ST FLOOR: ( <br /> °?•+ ' * I � <br /> 4, TOTAL SQUARE FOOTAGE: 1 ( <br /> 2ND FLOOR: 3RD FLOOR: ng1,54 ,„ <br /> 600 <br /> n r ' ��*r y•ESTIMATED CONSTRUCTION COST: u i s. <br /> (Please round to nearest dollar) "� -, $ yo/ eo0 ° ° <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes �1 Jo El Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes .a 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 pro erty in the past 5 years? ❑ r'es ❑No <br /> 5. Is this project associated with a rezone/CUP/varian a(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 )2No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back -► <br /> 545-112(4/08) ( ) <br />