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ZONING PERMIT APPLICATION iww.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE• AME r / /J <br /> � i, 5 Y <br /> Y V ► e ��s L` IA Zoning Status;CUP; <br /> OWNER•.DR S umb r reet,City,State 'p) U �� ��a Deed Restriction CSM�� 2' <br /> HOME PHONE CELL PHONE E-MAILA•DRESS —_ <br /> A❑ Site Plan drawn to sca <br /> AGENT INFORMATION CONTRACTOR INFORMATION - . ua=im- , : <br /> AGENT NAM CONTRA TOR NAM <br /> &' /tJ}U A ` 'N ' 1 G - �, •,, :, tL, ;j S Site Plan including locatio• <br /> AGENT ADDRESS C•NTRA .R ADDRESS / ,• i1 O <br /> )' 7 . 5 Chc�-l,?,b i� .% :rte-, 3* I 0� <br /> (City,State, ip) (City,State,zip) I�f Setbacks /O / ' <br /> PHON - - PH.1E u(/(/ I Si - "Ian approval from it <br /> _ '� I�� / / -/ ..e .. e . . .•• f. g <br /> E-∎AILADDRESS E-MAIL••DRESS I�`�❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.i:s/) ❑ Elevation of property <br /> PARENT PAR ELNU BE CURRENI/ONIN ACREAGE: <br /> PARCEL P cEL . , —7D��3 — frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: !!J SECTION: <br /> ru h 1/: 1 1 ® D;•�,-j• ay permits <br /> ADDRESS: - =,county,town) <br /> ? g5C �. G fles �4 <br /> csM: LoT susolvllON BLOC Lor �� Sanitary permits <br /> �_ --r-- (publicy,pl ,l <br /> PROPOSED PROJECT INFORMATION '•.TAFP REVIEW _- <br /> PROJECT DESCRIPTION: . x� - , - � 7 <br /> 3 �( �� e c- ,r$tea e <br /> his project is a new building or structure. �- `-t� S :1- ff <br /> 3 � � <br /> ti This project is n addition/alteration to an existing building or structure. �M , <br /> SANITARY SERVICE: PERMIT UMBER: °�° : - ,-� <br /> a SEWER ■SEPTIC " � `a w <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ,, -- � t <br /> gal . .6j.p ,r <br /> AREA TO NEAREST SQUARE FOOT: �" �. -a'� r , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) E - � ,� �"�~ <br /> BASEMENT: 1ST FLOOR: h <br /> © // 4, TOTAL SQUARE FOOTAGE: �, Q•e � <br /> a <br /> 2ND FLOOR: 3RD FLOOR: i i x� SSA l <br /> t _ PS fT""�"P' if <br /> ESTIMATED CONSTRUCTION COST: ' r;.c. c e iie i <br /> (Please round to nearest dollar) �� ._ - ..: P � �. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Lrf?ryO ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeso ❑Don't know <br /> 3. Have you talked with the township about your prof ct and are they in agreement? 12'S'es ❑No <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? ❑Yes �lo <br /> 5. Is this project associated with a rezone/CUP/varia 1 ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) J ❑Yes ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes R1Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -* —► <br /> 545-112(4/08) <br />