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, <br /> 4 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER`.:INFORMATION +.;. .!- . ' ; *... :.-, ,.- r,; ='- _r CUSTOMER TO PROVIDE <br /> OW R NAME <br /> 1GI`1n' k .c j Vc 6v,` L ❑ Zoning <br /> OWNER ADDRES N er,„reet,City,State,Zip) Status;CUP; <br /> ��'/ .ewe c 4 (Pet C& I seta -t-T Deed Restriction;CSM <br /> l• L f'" ►/ (n1 Variance(# ) <br /> HOME PHONE CE L PHONE E-MAIL ADDRESS <br /> O"55467 I ft OrSU 2 C v Site Plan drawn to scale <br /> AGENT INFORMATION ,- CONTRACTOR,INFORMATION:.; f and includes dimensions <br /> AGENT NAME (_ ',, CONTRACTOR NAME ..,� <br /> �br` Qi t'\k `` I S4 Co ..ct lid'Site Plan including location <br /> 0 <br /> AGENT ADDRESS CONTRACTR ADDRESS of well/septic <br /> (City,State,Zip) (City,S te,Zip) ❑ Setbacks <br /> PHONE PHONE I . ❑ Site Plan approval from <br /> , �'1L (pc OO— 7 12•---5'3' applicable township: <br /> E-MAIL ADDRESS E-MAILf°D RESS t <br /> .s1 a -4e , tl. ekii A ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION +_;(http://accessdane.coaane.wi.us)) <br /> PARENT PARC N MBER: CURRENT ZONING ACREAGE' ❑ Elevation of property <br /> ❑ <br /> NUMBER <br /> O3 �o70 t 43— AO Z (� �- $ frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> -fa,,.A. .��-40� t 1 ./: 5 (A) 1/4 : '�/ ❑ Driveway permits <br /> ADDRESS: ��,, l ,�n <br /> (state,County,town) <br /> ���2- 0, &"'�- PQh'�r" C-4-- "'P r8 0 `\ ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> i. -,4, . 7 64 (public,private) <br /> PROPOSED PROJECT INFORMATION, 41-� <br /> PROJECT ESCRIPTION: �" � <br /> ❑This project is a new building or structure. � ' �' <br /> Fes$ <br /> This project is an addition/alteration to an existing building or structure. - ' i 1 <br /> SANITARY SERVICE: PERMIT NUMBER: ('111-1°I1IY �: <br /> ❑SEWER PTIC I-+1 » wq ' , <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) , r = r <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,� <br /> BASEMENT: 1ST FLOOR: g� � q � F ; <br /> TOTAL SQUARE FOOTAGE: ' 'i .ar ii1 A t �� - <br /> z � r <br /> 2ND FLOOR: 3RD FLOOR: / ,„�� � ''� '"?.., :l..;:,,2- <br /> 1 qo Sf-� ^ -- r <br /> 1 kill lam 4 F y t. -;.. <br /> ESTIMATED CONSTRUCTION COST: --0. --► -•0. --0- --► -0. $ S� 0®ca . '��®'� i 3 <br /> Please round to nearest dollar , z. #, ,_ <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 L Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? a'es ❑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 ❑No LW-Don't know <br /> 7. Is this to correct a violation? ❑Yes t•No <br /> ��" q ! <br /> �2 APPLICATION MUST BE SIGNED <br /> 545112(4/08) <br /> / (Continue on Back) -► -► -► <br />