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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#• <br /> x PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME . <br /> V 2 Q.�i C „t Ga fl 14-ovri le i L i_J—. ❑ Zoning Status;CUP; <br /> OWNER $ -S(Number, City.pls.z+�k� Deed Restriction;CSM <br /> a 0( 1 � I .bi �-4 I it ,1 'kw �- r. 1/ Variance(# ) <br /> Hp�Mg CELL PHONE E-MAIL ADDRESS <br /> `� "3/� • ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and indudes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 506 e A5 to V e ❑Site Plan including location . <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> • <br /> (CBS,State,Zip) '(City,State,Zip) ❑ Setbacks <br /> PHONE PHONE • • ❑Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E•MNLADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/,'accessdane.co.dane.wi.us/) 0 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: AC EA <br /> ❑ mica. D�-Q8 z 03 O��• A-1 • C frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ❑ Driveway permits m t,d`4 /: V IA: <br /> --' — (state,County,town) <br /> ADDRESS: . <br /> ,, � �xC <br /> - / � a.z � 2 ❑Sanitary permits <br /> CSM: LOT r SUSD •N BLOCKILOT (public,private) <br /> Truce_loo Ito <br /> PROPOSED PROJECT INFORMATION ? <br /> PROJECT DESCRIPTION: ' r.R., ...... <br /> • <br /> • Ii is project is a new building or structure. <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> -,... a <i i A ti •• _ pEgMtrNUMpeR - — - .._ <br /> ❑SEWER ►'SEPTIC " • •, II a f <br /> HEIGHT IN FEET 3 D 1 • NUMBER OF STORIES: (Not bdud'inp basement) <br /> AREA TO NEAREST SQUARE FOOT. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT g qa 1ST FLdQ�gr� `� ,�L/Z i, TOTAL SQUARE FOOTAGE ,l <br /> 2ND FLOOR: 3RD FLOOR: ; <br /> . ss� � ,' • <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ,,r ♦ A (L CC) _ • <br /> 1. The property Is within 300 feet of a stream or 1000 feet from a pond or lake?........... ❑Yes 63 No .0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes E'No ❑Don't know <br /> 3..Have you talked with the township about your project and are they In agreement? Dyes ❑No <br /> 4. Has there been a zoning permit issued for this property In the past 5 years? IgYes ❑No <br /> 5. Is this project associated-with a rezone/CUP/variance(petition/appeal# ) (I 'a blank tf none) <br /> 6. Is a location survey required? (see reverse) 'Mies ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> • (Continue on Back) -► -► -P <br /> 545412(NDO) <br />