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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Q <br /> �c,Ii,v f 7r IQ1,J ping Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,,Zip) eed Restriction; CSM <br /> L16il� o0k /-' p/( Varian (# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (oqP•_ , I ' e Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site P ncluding location <br /> AGENT ADDRE S CONTRACTOR ADDRESS of S tic <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> PHONE PHONE ❑ Site PI pproval from <br /> ap ' township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> I loor p ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/), vation of property <br /> PARENT PARCEL NUMBER: CUURRENTZON`ING: ACREAGE: <br /> El NUMBER 6-) i-, O S I ct('-]I 6 A-l c ciOS, J d', ), frontage drawn to scale. <br /> TOWNSHIP: S ECT : <br /> ❑ Drive • .•er town) <br /> 1/. Iry '/4t/4.•ADDIRESSPf - -, cou ,town) <br /> u C Q L P'k a4 IR Sanitary permits f� • <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> • Y) <br /> PROPOSED PROJECT INFORMATION a i fn TAFF REVIEW . <br /> PROJECT DESCRIPTION: 1.-.f::1. <br /> 1 a. 1L a1 �.7 Q Q • _ , A� s�o e O�t' 5 °:1-%:-.. <br /> • [1This project is a new building or structure. � .if "` <br /> ❑This project is an addition/alteration to an existing building or structure. . V A f :, <br /> SANITARY SERVICE: PERMIT NUMBER: � = <br /> (SEWER SEPTIC ='' <br /> HEIGHT IN FEET: j�I` NUMBER OF STORIES: (Not including basement) ��4: �. - ` - .,0a-'" ' <br /> o1 -Vi'4 Rr. S t! <br /> AREA TO NEAREST SQUARE FOOT: <br /> -°:: > <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) I } �s <br /> BASEMENT: 1ST FLOO : / r s on o� O ° <br /> C- ti. <br /> , TOTAL SQUARE FOOTAGE: ,, I O®$ ' • ` Ty®- m <br /> • '-'-:t4.):'--- ;:::'=' s <br /> 2ND FLOOR: 3RD FLOOR: _ e <br /> S ,r 1. . <br /> ESTIMAT 0 CONSTRUCTION COST: • @0 „ <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? ❑Yes o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? El yes Jo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes u No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes Eilo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 'No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ��'I <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ –► <br /> 545-112(4/08) <br />