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ZONING PERMIT APPLICATION .countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / <br /> I"ti : 6, 4 `// <br /> -c.. ❑ Zoning Status;CUP; <br /> OWNERADDRESS (jmber,Street,City,State,Zip) Deed Restriction; CSM <br /> 2• 6 7 Sao✓ ',�5 �( 1� / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI A•DRESS <br /> Ga$ '� 3 C 7 75-% d5 , 4,2 ,, c6_1_) , (.Z ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> t ❑ Site Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRESS of well/septic <br /> (City,State,Zip) (City,Stat-,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL AI DRESS <br /> p Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ❑ PARCEL tG i/,/ 71_6 o ^- 1 -7 D frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTIO : <br /> El Driveway permits Pr 2u5� � 6 p �� '/4: /A: <br /> (state,county,town) <br /> ADDRESS: <br /> Z 6 L 7 Vokp H. 1( S r ❑ Sanitary permits <br /> CSM: LO SUBDIVI'.ION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF EW,, <br /> PROJECT DESCRIPTION: -4 <br /> a` u. i. t <br /> �ti r dc, S i^--� <br /> . ®This project is a new building or structure. <br /> M : Sep ��, <br /> ❑This project is an addition/alteration to an exist' • building or structure. <br /> SANITARY SERVICE: PERMIT UMBER: � ;,�° <br /> 11 Tess <br /> SEWER nSEPTIC (new� {) <br /> F \ .\ may^' <br /> HEIGHT IN FEET: ( NUMBE-OF STORIES: (Not including basement) ,t ff <br /> r <br /> Ow ,,aR o •c <br /> ( l h• a <br /> AREA TO NEAREST SQU'RE FOOT: �' 1 <br /> (Outside dimensions including unfinished area, attached g.rages and above grade decks or porches) € oil peliTp . <br /> BASEMENT: 1ST FLOOR: <br /> ii X /6 4, TOTAL SQUARE FOOTAGE: + .,/c,„,,-+ -�s `t e • <br /> �� �'c�le�,. i„ <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0 e �t4PP, Sum <br /> ESTIMATED CONSTRUCTION COST: ,rtd I+ <br /> (Please round to nearest dollar) ♦ ♦ _+ ♦ $♦ .p 2 v D v � , i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the prof erty? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your pro ect and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this pr•perty in the past 5 years? ['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 Q No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -♦ <br /> 545-112(4/08) <br />