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ZONING PERMIT APPLICATION ww.countyofdane.conl SUPPLEMENT to We6•App#; <br /> w <br /> PROPERTY OWNER INFORMATION ' CUSTOMER TO PROVIDE <br /> OWN F77 77 /� <br /> /l —`Ylfj Z Zoning Status; CUP; <br /> OWNER ADDRESS (Number, treet,City,St te,Zip) <br /> _ Deed Restriction; CSM <br /> �-79-V) 0ar.1',',,sJ,'/k kJ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> S -7-t400 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> H Site Plan including location <br /> AGENT ADDRESS CONTRACTOR A. RESS of well/septic <br /> (City,State,Zip) (City,State,Zip) \�❑ Setbacks --(7)/) <br /> /VC CG,a <br /> PHONE PHONE ❑ Site n a val from <br /> appli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (Iittp://accessclane.co.dane.wLus/)us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCEL frontage drawn to scale. <br /> LI NUMBER (�OSS C» �q l LI 0 � R - i ��`6� J� <br /> TOWNSHIP: SECTION: <br /> SiOt �r,� ❑ Drives _ .-rmits <br /> (s . -, o • y,town) <br /> ADDR-7 S: <br /> 1 0 rf)c e )-,,,,,, (I l -e 6 I a . :.4:-rmits CSM: LOT th SUBDIVISION BLOCK/LOT (p • 'c,p .te) <br /> PROPOSED PROJECT INFORMATION A° ""iEW <br /> PROJECT DESCRIPTION: /� / ,P` . :, } <br /> rorck /�c0 '4onmg-®(s c sue,: <br /> • ❑This project is a new building or structure. i 1� <br /> El This project is an addition/alteration to an existing building or structure. r �� s Yn, , <br /> SANITARY SERVICE: PERMIT NUMBEf ra "d a ,{ t <br /> ❑SEWER j5ISEPTIC _,,,, 'j� pw <br /> HEIGHT IN FEET NUMBER OF ST IES: (Not including basement) .1 f' - '�T 4. ,'_ <br /> fgl `.etlal l�,JD®a �. <br /> / P <br /> P4;•'. hor ` attachment) <br /> AREA TO NEAREST SQUARE FOOT: a, *„«, � _ ,e-4t -4- V <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) T�S�� , a o a E(4...,.::„ <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: �, c O B g e e a <br /> _ <br /> x E •max, "#;- <br /> 2ND FLOOR: 3RD FLOOR: . <br /> ti. � ra1Pl <br /> ESTIMATED <br /> CONSTRUCTION COST: g a a6 m o ?e <br /> (Please round to nearest dollar) "� ♦ ♦ ♦ Y: ,;.1-� <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? ❑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 ' 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 ril No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes P-4No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -4 --► <br /> 545-112(4/08) <br />