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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENTaoWeb•App#' <br /> PROPERTY OWNER INFORMATION ' CU-TOMER TO PROVIDE <br /> OWNER NAME e/1- ,a i CKeiSD4 El Z ing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ed Restriction; CSM <br /> GGli 55 e P SD n ariance(# ) <br /> HOME PHONE CELL PHON E-MAILADDRESS <br /> 0f V51-Sa- ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION = , and includes dimensions <br /> AGENT NAME 4 CONTRA TOR NAME <br /> 4:af ✓Q� Se 2-1 /61 5r/7-z y r� &4 (`J , Ite Plan including location <br /> AGENT ADDRESS , CONTRACTOR ADDRESS (well/septic <br /> 7 3 7 G/, M 111//1 /,/✓ <br /> (City,State, ) P , (City,State,Zip) Setbacks <br /> 5,0g ew/ w4 s 7 .g/ <br /> PHONE PHONE ❑ Site Plan royal from <br /> /ag=2 7'/-7asy ap ot plans i le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> lo to scale <br /> PROPERTY/LOCATION INFORMATION (http//accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PAR E NUM R: 1/ C REN ONIN : ACREAGE , <br /> ❑ NUMBER 0 �1 a , 1 ^ N frontage draw o scale. <br /> TOWNSHIP: STI • <br /> PPsif I . ,/:S E I N '1 El Drive permits <br /> si r 9. �i (s ,count ,town) <br /> ADDRESS: <br /> 7 9 -5 5 Hpn5ei,H 's Pr. <br /> r n Sani permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT p lic,private) <br /> 7115 1r 1 , C � y _ <br /> PROPOSED PROJECT INFORMATION ' ;'`"STAt.-F•REV.r <br /> PROJECT DESCRIPTION: (— ° 7 ^ � �r <br /> G -: '®nmg D sI <br /> ❑This project is a new building or structure. ;' -� ' - - <br /> P j 9 64 p:rml <br /> ❑C This project is an addition/alteration to an existing building or structure. 1_- ,ai_- M <br /> SANITARY SERVICE: PERMIT NUMBER: �'....4,,,,,,-- e ;� x,, ' <br /> F1SEWER FSEPTIC : . te X <br /> JJJ <br /> HEIGHT IN FEET: y �,( NUMBER OF STORIES: (Not including basement) ® � z " i <br /> [/ ' VI.ettan e; pod; <br /> 5ho arid"�(attac a nt) <br /> AREA TO NEAREST SQUARE FOOT � ` ;4q`'-4`.-� ` <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) �rg 'tit .- °� .„1 <br /> BASEMENT: 1ST FLOOR: fi ` ® �TOS1Of' 0 1 O;P1 � <br /> 1���/// d / 4 �1 re '1 <br /> 4, TOTAL SQUARE FOOTAGE: E( e ▪ �st_r•ancee <br /> MP t access ,1, ,'-r <br /> 2ND FLOOR: 3RD FLOOR: xt -rya n <br /> wla'Revte ▪ -oca'a onSury- �= , <br /> ESTIMATED CONSTRUCTION COST: �, ( ! 1 ' <br /> e*fion : a --•- <br /> (Please round to nearest dollar) --► -+ --► —I. ♦ - --;• <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? EYes El 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> I f APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -4 - ' <br /> 545-112(4/08) <br />