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'f–f"?‘1 SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N € <br /> IA V r S kvu <br /> ❑ Zoning Sta s; P; <br /> W <br /> ONER ADDRESS (Number,Street,City,Statt)Zip) <br /> Deed Rest ' ion; CSM <br /> T Iac3 Swo hoc fJ UNI ( ) <br /> � '� � ) � Variance # <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60% 5i . aaIg al Site Plan drawn scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and include • tensions <br /> AGENT NAME fi CONTRACTOR NAME <br /> it,lts n c� <br /> ' S q IM1 M Site Plan includ' ocation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s <br /> 6601 Show).)-■ f v <br /> (City,State,Zip) ( (City,State,Zip) is Setbacks <br /> (//)'\0-(.7t) ti� <br /> W/ <br /> PHONE PHONE M Site Pla ...• o om <br /> Coo 6 c y qlo'-) applica• et• hi . <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> in PARENT PARCEL NUM R: xci(1RRENTZONIN_G: ACREAGE:I❑ NUMBER ( �� - Af �(1\ , 0 i frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> t`al°i�t:�i�.i +/; +/4+/,: M Drivewa <br /> ADDRESS: (State'C l t n) <br /> n ,+� / , <br /> crJ�� ) 7 77 4nlca t$ (� <br /> CSM: LOT 61 S IVISION , BL CIULOT •(public, permits <br /> �k ipoi (public,private) <br /> PROPOSED PROJECT INFORMATION --= a -3 j "`,: <br /> PROJECT DESCRIPTION: , <br /> This project is a new building or structure. '_ ; <br /> • <br /> P 1 9 X11 i �� <br /> ❑This project is an addition/alteration to an existing building or structure. . '-“,--,.,:7:::::. ,,,...,::::2; <br /> �': <br /> SANITARY SERVICE: PERMIT NUMBER: c� �4 4.__<— <br /> SEWER SEPTIC ‘3 _a "OO c�t�� I- _ f A . "2,' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) _, °n om „ <br /> A EA TO NEAREST SQUARE FOOT: � .'' = $ <br /> (Outside dimensions including unfinished area, attached ra es and above grade decks or porches) i. <br /> BASEMENT: 1ST FLOOR: <br /> Mi -3� 3906 �, TOTAL SQUARE FOOTAGE: 4, ,-i"�T 1�t{s.14 q,,._r <br /> 2ND FLOOR: 3RD FLOOR: ��© , J <br /> 156 �!ft ' <br /> ESTIMATED CONSTRUCTION COST: .4. .4 .4. $ �6 Fyn t7,'-' i .i 7:-1 IF , z o�e rz.� , <br /> (Please round to nearest dollar) <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 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yesl]]No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes El 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) Dyes No ['Don't know <br /> 7. Is this to correct a violation? Dyes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -4 - <br /> 545-112(4108) <br />