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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to web-App#; <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW NAME /' 1 1 <br /> rL14I x VNJ1-e ti..o c oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,S te,Zip) Deed Restriction; CSM <br /> p.4-7Es C'( 4 1 Variance(# ) <br /> HOM PHONE CELL PHONE E-MAIL ADDRESS <br /> S 14$ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 11-43?te Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip etbacks <br /> PHONE PHONE ❑ Site approval from <br /> ap c le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -F1Or plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wi:usl), _. evation of propert <br /> PARENT PARCEL NUMBER: CURR 4NT Z\NING: y AC 1=1 NMBER O0/1 .-331-9�Oo-. <br /> frontage drawn to scale. <br /> TOWNSHIP: S T <br /> �C�r ,/. SvJ ,/,/: �'� ri ermits �� <br /> ADDRESS: , (Stat unty,town) <br /> G In t crn TT Sanitary•- its <br /> CSM: 3 J S:3 LOT ' SUBDIVISION BLOCK/LOT (public p •°- -• pi 19 NQ <br /> / , <br /> PROPOSED PROJECT INFORMATION 7•S AIFF R 1VER EIN <br /> PROJECT DESCRIPTION: ,^ c�i £, ..",-- 41 1 <br /> . Lip ry /4►/ o c.K, • ✓� 'Q v/ a-i r.r a n e�U`g�e '_ a'. a '' <br /> • ❑This project is a new building or structure. , l4 ^ i#o <br /> his project is an addition/alteration to an existing building or structure. x . <br /> SANITARY SERVICE: PERMIT NUMBER: J !i L' . . <br /> FISEWER SEPTIC W {..! -� �' <br /> / '} 111 "` �4 �%� � ri"� p;�`', <br /> HEIGHT IN FEET q NUMBER OF STO S: (N including basement) ,,- .A.A" <br /> e anV6flr a -7".•.. ...-',..-. <br /> �t O `S r dhme t,)x„. <br /> AREA TO NEAREST SQUARE FOOT: `_. t7 . , <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) "� i- <br /> `�®. a e Ero pt a `o g E� <br /> BASEMENT 1ST F�O.OR: v :" z; <br /> `IT/ Cl ,+, TOTAL SQUARE FOOTAGE: ,j, a-i Ode ,:,5�r'r°an -' <br /> 1 £ 6gsyats � 2 <br /> 2ND FLOOR: 3RD FLOOR: c _ 'cam'.'-_ <br /> ESTIMATED CONSTRUCTION COST: ` k', o o e 7j` <br /> (Please round to nearest dollar) ♦ --► --► ♦ ♦ ♦ v 7.9 <br /> „ - ” <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'? ❑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 none) <br /> 6. Is a location survey required? (see reverse) Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ►_j es ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -4. -► <br /> 545-112(4108) <br />