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ZONING PERMIT APPLICATION www.countyotdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> A41, a- An'?C� Ma/fhti ❑ Zoning Status; CUP; <br /> O�/W+ANER ADDRESS (Number,Streett��Ciiitty,State,Zip) Deed Restriction; CSM <br /> HOME PHONE 7� CELL PHONE -Sct--LA7 ADDRESS <br /> vk ( e Variance(# ) <br /> ," 7R 0'S.19 • )) ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME NAME CONTRACTOR NAME <br /> /ONI L4 Al )'4'S c4.1 �th rc�(h —/grkSY c��� 5 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /.2'O 4f ELI f=GvPvtt:5-7 A/ . S7 1, L.-/itrlcyr,.d a• <br /> (City:State,Zip) , 1l (City,State,Zip) , 1 ❑ Setbacks <br /> 1VJiev�,IA W0 c.S 53 SLtH /3 /(.,-e Cif 5 3S�c� <br /> PHONE PHONE r ❑ Site Plan approval from <br /> (g J.& 23 s-. / 3 G, E5 6,3 .2.367 /&4,46 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • <br /> ❑ Driveway permits <br /> '/4: '�4'�4 (state,county,town) <br /> •ADDRESS: ;;�� l n <br /> Ci'3.3 T-71-64 , ti cV /SIP - JC-t Pi 10c\t 't tie ❑ Sanitary permits <br /> CSM: LOT / SUBDIVISION BLOCK/OT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> A i't TAFF REM <br /> PROJECT DESCRIPTION: [ 411-A �/ �F g t <br /> -t.J0 IJ1eCh 5 c-�iYq' /T X ((. o a lazy �, <br /> . This project is a new building or structure. `�.ii- ro t, <br /> This project is an addition/alteration to an existing building or structure. ,: � <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> *00_, .,mt <br /> (SEWER (SEPTIC ex1s I..@i-`x3` Y` "t«";' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) " ' ,i �"+x --- <br /> 3/ q .. etldn s God �; z , <br /> �*• ore ao• r .. <br /> AREA TO NEAREST SQUARE FOOT: - - . tt, <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ale' ` £> k'L- <br /> � TBSID a�t p�s i � ,,,,.' <br /> BASEMENT: 1ST FLOOR: - r <br /> ,� TOTAL SQUARE FOOTAGE: °r ° t rGa ': --V z <br /> 2ND FLOOR: 3RD FLOOR: ,' iI i��1 <br /> 44—C6 # Vie-•.-t4 0 <br /> ESTIMATED CONSTRUCTION COST: -- . p ?i e <br /> 7 <br /> (Please round to nearest dollar) --► -► -0' d 000 a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes S No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes IZ No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes ❑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 E No ❑Don't know <br /> 7. Is this to correct a violation? Dyes 64, o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -I. - <br /> 545-112(4ro8) <br />