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ZONING PERMIT APPLICATION www.countyofdane.conl SUPPLEMENT to web•App #: <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2 2 0- S G,A ......` . - Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4436'33 S Q%1' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> rt4 Arc-a...4 <—•'3'.v rya rie - > ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRF S of well/septic <br /> e----- , o • l i 333 <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> Cara d23 —4:g •73— bS7=' applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 1 ti4 MATJ Ji- VU • ,❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:!/accessdane.co.dane.wi.us!)„ _ __ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAG : ❑ Elevation of property <br /> EiPARCEL <br /> NUMBER ■----i( \ 2-t e c w-d frontage drawn to scale. <br /> TO SHIP: SECTION: <br /> 1‘...r\^- — ,/4: ,/,A: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION SS# f <br /> REVI - <br /> , �r PROJECT DESCRIPTION: <br /> ,) c.:7-14,4.4,,t C 0.„A.../-fit _ •toTl o D S¢` � _ <br /> • l This project is a new building or structure. @� if,-,,,-;:*, <br /> ❑This project is an addition/alteration to an existing building or structure. ±-d , c: <br /> SANITARY SERVICE: ∎ o r <br /> PERMIT NUMBER: ����■'{j S <br /> nsEWER nSEPTIC -` ” I ± ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) —,�---�}-�, � � <br /> etp coo®a— '' ,,-; <br /> AREA TO NEAREST SQUARE FOOT :• �,,,,n-=------ --,-71-I6 Y - ,? <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) r <br /> f a Ion,C0r 0 0 E - <br /> BASEMENT 1ST FLOOR -.4 <br /> 4, TOTAL SQUARE FOOTAGE: 4, ode '_`o.i T6®rlalo�. 7 <br /> 2ND FLOOR: 3RD FLOOR: .T E <br /> ESTIMATED CONSTRUCTION COST: +s oQ� �. GMb� o <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 to Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes o ❑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 e) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -9- —► <br /> ( ) <br />