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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAME <br /> .0 ( t� C.t .&c-L L ❑Zoning Status;CUP; <br /> ER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2) Co C 0 t�ti-- zr-_ �� a,.._ V-.'i_ 5-3 11 Variance(# ) <br /> HOME PHONE CELL PHONE E- IL ADDRESS <br /> ;.•`6-8 1"?-( ( ] ,og-ZZS-BUS G(•-•kflt - 4 .SbG Globs- ❑ •Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ©w IUC41" ['Site Plan including location <br /> AGENT AD*'" CONTRA DDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS 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: CURRENT ZONING: ACREAGE: <br /> ❑PA QQ �/ frontage drawn to scale. <br /> NUMBER RCEL 3 <br /> dl�ba2.s33 ii8 R� <br /> TOWNSHIP: SECTION: <br /> N7 <br /> ti <br /> '/a: %a'/a: II Driveway permits <br /> ADDRESS: (state, county,town) <br /> 3' qco, Q )0,A%-by-- S - '' S-3S8c-j..S ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION fS F IEW J <br /> PROJECT DESCRIPTION: ,Z " " <br /> r <br /> c.)la.c� y k& ' t S t o p e. floc- Cif dab —Cc�.1s5 C15Vt-•0 v •�� # <br /> • ❑This project is a new building or structure i• ,� • i.; <br /> This project is an adiitierr/alteration to an existing building or structure. . 4', <br /> t •o S <br /> ANITARY SERVICE* PERMIT NUMBER: t a <br /> EWER �EPTIC • x` u <br /> �,y r - A <br /> HEIGHT IN T: (\/ NUMBER OF STORIES: (Not including basement) z` *# ` ' '` <br /> �� ` { Slhore ne „ a c 1 0 , F <br /> AREA TO NEAREST SQUARE FOOT: ” ` �* #' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �h�q` ,� ' k <br /> Er• t1 '• l penal. <br /> BASEMENT: 1ST FLOOR: r ^ "it 'Ir,+ 4 t '�` <br /> TOTAL SQUARE FOOTAGE: f (s,••ei • r•- pia, <br /> 2ND FLOOR: 3RD FLOOR: i • '7i <br /> ;IS-6 2_T ,� t 'jj up,., <br /> r� �• • : Tr 'r�s <br /> ESTIMATED CONSTRUCTION COST: a 1l1 <br /> B.`o -• - •• WQ � r <br /> (Please round to nearest dollar) ♦ --► "* 30,606 - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? I('es ❑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? IYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ENo <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) JYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? Des No <br /> APPLICATION MUST BE SIGNED <br /> Sae-,tz(4/08) (Continue on Back) —► --► - <br />