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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME_, { f_ / ` <br /> 7I4 " 5 L E�74 L L j` ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Cl'g 'i4 YH ort c • 0 gi�-o I solo (A)(, JAS 7 Variance(# ) <br /> HOME P'70- <br /> ONE ELL PIjONE E-MAIL ADDRESS <br /> 05 - ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGEIIT,NAME CONTRACTOR NAME <br /> eg.17.9 S 2 ElJS e i ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic well/septic <br /> 3s-"tr2 F( Dyi,esafr) ��of <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHO 46- -e L (0 0 w 1 t C3 �" PHONE Site Plan royal from <br /> -t `1 3` t0 cr? ❑ approval <br /> 7 � applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: �j�] CURREN ZONING: ACREAGE: <br /> El NUMBER n 3 6/ 7oS L3 P/ [V o"`7 A l /, z S—!, frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> To , ,/4,/4. ❑ Driveway permits <br /> ti DD LFT6lU �° (state,county,town) <br /> ADDRESS: <br /> 70 5-0 V4 y/Y <br /> c iu D Q. D ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION It <br /> PROJECT DESCRIPTION: <br /> . This project is a new building or structure. © Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> LI Rur I .f <br /> SEWER nsEPTIC (new/e 4 ': ° <br /> HEIGHT IN FEET: ' NUMBER OF STORIES: (Not including basement) ` <br /> ? ( U We ...rain/ <br /> Sh_ ' . n <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Erosion <br /> /f o 2'2 �e- y TOTAL SQUARE FOOTAGE: 4`" t <br /> 2ND FLOOR: 1 3RD FLOOR: fin. .°, '. <br /> 2 5 .� -,, .'A ; <br /> U Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ G�� . tf,° it ., s <br /> (Please round to nearest dollar) 2CQ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 12 No El Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ea Yes ❑No <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />