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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 /> I y L E4- SP/cc E L El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /Z 7—2_ t)/Gr1-l&#+ .i / '4 0�EC4OA/ w/s. 5.35 5 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> &08-S7C-08 T5 lob$-SDK-08`}S SP/E C g-L LS 0 4 . Cis-1. L Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> OED//E S-10/E4E L. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 94l-q/ /1/LL <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> oyo,./ Au/. S� S�� <br /> PHONE PHONE ❑Site Plan approval from <br /> /mob pj — -."9-c— oj.c' applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SiD/E EL z8@ /4a4-, Cro ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER d 5/0 -0-7-Z -515 0;6 C- z <br /> frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> evT4.)414 D V4: IR : ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> /Z z a. /II/4''t 4.04-1/ `tt ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STOP REVIEW <br /> PROJECT DESCRIPTION: <br /> /4 bD1ti./67 ,J 0J-E ii?/447t/ r ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rurais <br /> EWER K E P T I C ( ) <br /> HEIGHT IN FEET: NUMBER V1k STORIES: (Not including basement) ❑ tland/F1QO la1N <br /> / Sid (moment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErOS OI*Eil <br /> BASEMENT: 1ST FLOOR: I TOTAL SQUARE FOOTAGE: 1 (aloes,d bane, <br /> fillinglacCess <br /> 2ND FLOOR: 3RD FLOOR: ♦ Z ) <br /> ZS ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -0. -. -i. -. $ /500, ° v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives EIN o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'lo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes EINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves a o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#/08 )-I ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes to ['Don't know <br /> 7. Is this to correct a violation? Dies ON o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -+ -+ <br /> 545-112(4/08) <br />