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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> •^�Al ME 4 , cw <br /> Zoning Status; <br /> OWNER A�DRESS N m us, CUP; <br /> ( ber,Stree,City,State,Zip) g <br /> S - t C_ v C� G(.111) S35�Ste' Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PF�ONE _ E-MAI ADD SS <br /> -� Si).S � 5�� A� /c�� a o o . 0 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A(Aj NAM / CONTRACTOR NAME <br /> t ''r -) ❑ Site an including location <br /> AGENT ADDRESS CONTRACTOR ADD" SS of II/septic <br /> (City,State,Zip) (City,State,Zip) r� Setba ks <br /> PHONE PHONE - ❑ Site a pproval from <br /> appli le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CU ENT ZONING:(http://accessdane.co.daAnceR.EwAGLEu.s/) Elevation of property <br /> ❑ NU <br /> NUMBER JSQ�} / I Z - C`3,5?�- 3 3,J A- frontage drawn to scale. <br /> TO,W'NSSHIP: SECTION: �/ yM1�/`, `/ <br /> j �/✓Q4�� l f 1/4. /Y (J 1��A. Y _ Driv rmits <br /> ADDRESS: �— (St ,C nty,town) <br /> c2 LI C4 `I C�— 0)( GUT' ❑ Sanit permits <br /> cSM: LOS BDIVISION BLOCK/LOT (p IC,private) <br /> � 9 Z <br /> PROPOSED PROJECT INFORMATION STAFF� 5 : <br /> PROJECT DESCRIPTION: j n' 4 ii <br /> - x '"� 0 (� O •f _ Zoning District : °,; ,, <br /> . erThis project is a new building or structure. <br /> Permitted Use? <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: Ru al ° • s <br /> ,, x❑SEWER SEPTIC : ( e exrn+ <br /> HEIGHT IN FEET,— NUMBER OF STORIES: (Not including basement) ;', 1 <br /> q, -7 % ❑ tNett roAtTn/ <br /> AREA TO NEAREST SQUARE FOOT: h (attachment) r <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , <br /> ❑ rosl• ! ktYl' ermf <br /> BASEMENT: 1ST FLOOR:' i � ��� �� ,� <br /> l \.� �'1 (� j TOTAL SQUARE FOOTAGE: , (Slop , ® turbance, , + <br /> 2ND FLOOR: 3RD FLOOR: Illlrt a acce s) <br /> (� � <br /> ❑ Review attori Survey <br /> ESTIMATED CONSTRUCTION COST: � � �fi <br /> (Please round to nearest dollar) '� "� •'► -► C� U and a !121(3 options <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 2.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? .Yes ❑No <br /> 4. Has there been a zoning permit issued for this property 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 NI No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 4110 <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) --► --► -o <br />