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a <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ..?*H .//1,6,■f'ft , .. <br /> ❑ Zoning St s;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed strictlon; CSM <br /> o?/01- f��7- /`'.P. 9a <br /> Vari ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> OR-ds-'-G G 1"/ 40E3-6,5'g-g,- 13� e l/e.,4.-Q.nialr4D:' - Waite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME r CONTRACTOR NAME <br /> *( ite Plan including location <br /> AGENT ADDRESS‘S CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) •\v\ (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ Site Pla proval from <br /> applic le tow ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ loor ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL PARCEL NUMBER <br /> CRENTZONIN`: ACREAGE: . 0 Q <br /> ❑ NUMBER <br /> Q�O•7 . ,� �/( frontage draw o scale. <br /> TOWNSHIP: NI c%`\ eke. SECTO <br /> '/a: IN) '//: N ❑ v nrm <br /> (st e,count own) <br /> ADDRESS: 0? <br /> ©� Rtv.i N <br /> ❑ Sani - permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (p?, ic,private) <br /> PROPOSED PROJECT INFORMATION REVIEW <br /> PROJECT DESCRIPTION: .)/ ' ;r -F <br /> )(c a onhig District t <br /> project building p. <br /> ❑This ro'ect is a new buildin or structure. Permitted se? <br /> This project is an additio /alteration to an existing building or structure. ' <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural A <br /> Fnew! ' Istfn '' i <br /> ❑SEWER EPTIC ,4 x A <br /> HEIGHT IN FEET: Q / NUMBER OF STORIES: (Not including basement) �' y <br /> / ❑`V1letlandl a odjala0 <br /> S[hor nd a�chm <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ lOSIOn Q ltr• ,E',,,ip# � <br /> BASEMENT: 1ST FLOOR: !) ' f nc e <br /> a '^I} + TOTAL SQUARE FOOTAGE: j (slopes, ( ,I?:-4-1 o <br /> fllfmg/as)� <br /> 2ND FLOOR: 3RD FLOOR: acoLi ❑ R-view Loca iot Survey <br /> ESTIMATED CONSTRUCTION COST: $ 5 © i1 d avallabr opt,ons. <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? C Yes ❑ ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (lea a blank• none) <br /> 6. Is a location survey required? (see reverse) ❑ es No ❑Don't know <br /> 7. Is this to correct a violation? Yes ❑No <br /> /11 , APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —s <br /> 545-112(4/08) <br />