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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#'; <br /> PROPERTY OWNER INFORMATION ' ,''= CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Rah -a--T- I -4"1e Gc,c''o n Zoning Status; CU <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed 3173 bk.)NCAA (ZC ., STOOL -1 C , �T. Variance(#ic'on SM ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> gOS= rn-Oea — A cw 1 C► -t.Ncv n Site Plan drawn o scale <br /> AGENT INFORMATION, - CONTRACTOR INFORMATION': and include d' ensions <br /> AGENT NAME CONTRACTOR NAME <br /> rJ,j ' t a v i id-r1:5 a Cbrorwuor An n Site Plarr inclL Ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se ti <br /> n <br /> P0,r ,, 3(1,. -- k <br /> (City,State,Zip) (City,State,Zip) ❑ Setba�Ks v .�I N�4 <br /> ICA-t�Sc \ Cl2ec-k-,L�r- - V <br /> PHONE PHONE ❑ Site Plan r N rom <br /> j_ 3 applicable o <br /> ��� sill <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> vdoei-s<1;a-/a 1V'( icLSe r+ 1,C/"` ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION`(littp://accessdane.co.clanO:wi.usly.:.;,,,-- <br /> _ _ ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> LAJ,43 or &'A)AJ 1/4: ,/a1/4: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 3/73 0J.0 C A iJ 2d1, S400e N7 W <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, Air) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAF�REVIEW <br /> S MG/// , 4 t,11 4 v&Y° ' ei onmga iI c � ,..,. : <br /> . ❑This project is a new building or structure. 4E1ermltt= se ; <br /> V]This project is an addition/alteration to an existing building or structure. ^,.-.� ,, <br /> SANITARY SERVICE: PERMIT NUMBER: Rra7 Add es -t.`� <br /> (SEWER SEPTIC l'''''. 4- - '� '" - ,W.HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) *: --.. "� .:,1 <br /> fT �Wetlan 6- oo 6.® a �. <br /> /% 'Z- � 5 eln• rc-hmeri j, <br /> AREA TO NEAREST SQUARE FOOT: n4� x Vt I ..' '7.a <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ` `- =: - <br /> BASEMENT: 1ST FLOOR: ® ErosionGon 7 pen131t <br /> �� 6� 4, TOTAL SQUARE FOOTAGE: 4, r ? alC e�` <br /> (7 fi /access p <br /> 2ND FLOOR: 3RD FLOOR: �� -§-- -4 .. - <br /> /la `/ Revle ,r4 - <br /> ESTIMATED CONSTRUCTION COST: �` T `:::7 �_ <br /> ♦ -► -I► -I► -� 'clr3(IY = i ,o tOn to <br /> (Please round to nearest dollar) ,. x1 3„ i._ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes l No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes 0,Nlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes plio <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 lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ( lo <br /> t, <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ - -9 <br /> 545112(4/08) <br />