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'I 'l ∎'0 0,g, I • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> A ra°Itli <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O ER NAME l� <br /> �/1 f gbbc Mi,. <br /> OW DRESS (Number,S ,City,Sta ,Zip) ❑ D- �', ►t.tUS; UP; <br /> b ;, r\-iL7V C CYd /0.1`4 J D R : i ; CSM <br /> Var:nc- (• ) <br /> HOME PHONE CELL PHONE [' E-MAIL ADDRESS <br /> ,, -5�-6�c 1 C6.40- - "I 1 .c,0 i 1)c, (01K ❑ Site Plan dr wn to cale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and include d' ensions <br /> AGENT NAME CONTRACTOR EAME <br /> "DCLA. 4.1 0 uJ Gl.>w ❑ Site Plan including loc ' n <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> .4 ( SOrs C-4 <br /> (City,State,Zip) (City,State,Zip) ❑ Setb&etks <br /> PHONE P NE ❑ Site Pl.r ap,r ,. .m <br /> I66 9 -.1O - 6C30-1 applica�,l: t. ' s '1. <br /> E-MAIL ADDRESS E AILZ.RESS El Floor plans to scale/v, <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ` J <br /> PARENT /PARC NUMBBE�R�-y/ p]T� RR]ENNTTZONING: ACREAGE: ❑ Elevation of pry(peOy • <br /> ❑ NUMBER uskItt080, 1 W` 0 Rh/ btfg va .,,, 9/r� 41_04.) _ frontage drawn d scale. <br /> TOWNSHIP: / i\ SECTION: IL . <br /> S� ` Il� % L \� 1/ 1/1/. Dri VC's/ia� its` A I e <br /> 4. 4 4. �V/ <br /> ADD ESS: _ J(sta ,co ty,town <br /> i rat g +�d Ct't # �3 2 kti�mil <br /> c M: LOT SUBDIVISION BLOCK/LOT (public,rypefmits i, <br /> �t (publi private) <br /> ' ; • • • . • • ; •J F•RMATION ;'S 'REV'IEW '. <br /> PROJECT DESCRIPTION: <br /> l � <br /> . gi This project is a new building or structure. <br /> 0 I~'errnttt ?� <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> L: ,. <br /> SANITARY SERVICE: PERMIT NUM � � <br /> n Za l 32 6-, <br /> SEWER SEPTIC <br /> HEIGHT IN FEET: 2_--2___ NUMBE tom'-STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) � ' <br /> BASEMENT: 1ST FLOOR: tram trot''!emit <br /> -Z d7 3 t-1 9 , L. , TOTAL SQUARE FOOTAGE: ,l (slope , f�I anF , <br /> 2ND FLOOR: 3RD FLOOR: <br /> _1 �{ a1 0 spa <br /> 1 L 6 c I ql ' � a a n, y, <br /> w <br /> ESTIMATED CONSTRUCTION COST: <br /> Q etch <br /> (Please round to nearest dollar) ♦ ♦ -+ ♦ ♦ ♦ �V („ , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 1E1 Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 12-Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes RNo <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 n No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -, <br /> 545112(4/08) <br />