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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 /> 11a+t , Ho 114 Fehrsor1 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Numb Street,City,State,Zip) Deed Restriction; CSM <br /> Li 17 a. H 791, Si- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 31 ' — a5-, ' 0 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT N ME _ CONTRACTOR NAME <br /> ;CdO (N EI lerrv10.n Q.uiilley (-0,-\53 .Se.r V(Ce5 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> a N 1.._(‘/I.r■c S'i�� s.I- W1 E Wilson 5� <br /> (City,State,Zip) �� (City,State,Zip) ❑ Setbacks <br /> �o1r5o� / �.�- 1G3 Mad/ , OJT 5316' <br /> PHONE PHONE ❑ Site Plan approval from <br /> -(67o) 3a°t '—O 3 3 5 -77- L) a� 1 applicable township. <br /> E:MAIL E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.diane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURB TZONING: ACREAGE: <br /> ElPARCEL O t JoG 10 -6`13-6133-0 F'""3 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> J-7 oi- . 0 Don n 0❑ Driveway permits <br /> 1/41/4' (state,county,town) <br /> ADDRESS: <br /> L 17a W--1/'ol k $'r CI Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> 1� 7�iFF RE 1�EYYx <br /> PROJECT DESCRIPTION: <br /> De_L ® Q 2,,, A <br /> . ❑This project is a new building or structure. , :1--, <br /> -.This project is an addition/alteration to an existing building or structure. , <br /> SANITARY SERVICE: PERMIT NUMBER: a 3 dd S €W <br /> F1SEWER SEPTIC a e'isttng, g`g <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) , Y ;- ; <br /> 4" e!- o saoo - 1' <br /> ` PS©e a a: a r- meat) <br /> AREA TO NEAREST SQUARE FOOT: ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 1 <br /> o� a a a s 1 <br /> BASEMENT: 1ST FLOOR: b <br /> 4, TOTAL SQUARE FOOTAGE: 4, a• <br /> 2ND FLOOR: 3RD FLOOR: 1 9 L o � <br /> ESTIMATED CONSTRUCTION COST: $ 9 6 Fi0 -att a ®a`� '" f <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ --► $ 1 ��: '' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 171No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes jNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? CISLYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes c 1 to <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 l;i,! 0 (OA Don't know <br /> 7. Is this to correct a violation? DYes ►' o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back ♦ -► <br /> 545-112(4/08) <br />