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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER N E (� e� 0(4z- <br /> OWNERAD ESS y ber,Streit, ity,S e,Zip) 11 ning Status; CUP; <br /> ��" F f,'L I4 tu U eed Restriction; CSM <br /> L7 ?�� ariance(# ) <br /> HOME PHONE CELL PHONE (� E-MAIL ADDRESS i <br /> ��' �1 .• Z l,�'� •ite Plan drawn to scale <br /> AGENT INFORMATION CON tRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME (' I <br /> ? (�Q) - rL�K r%)C.L�?' (!O%.'¼.3 a hte Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRE of well/septic <br /> ifsi(City,State,Zip) <br /> (City,State,Zip) )� �� ` '` SetbaCl(S <br /> 0Lc6 c+� r�c -J 1 l g <br /> PHONE PHON �,ct El Site Pla pproval from, " <br /> �✓ r 'S appli le nship. ��` <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS <br /> �l/L.(' , <br /> �� ❑ lo plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: 1 CURREN ONING: ACREAGE: _ <br /> ❑ NUMBER 0 '' /S ^�3© Q r I_ ` y frontage dra to scale. <br /> TOWNSHIP: ,r SECTI N3 1/4: sE .1/4,A � 1 1 , : Np ❑ Drive y pm/ (st ,countyer,townits ) <br /> ADDRE3s: <br /> J( 3 bi kr Circl-te ❑ Sanit- permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> j/ ? �1(� a ,sa c,private) <br /> "� V V <br /> PROPOSED PROJECT INFORMATION <br /> AI( F l� <br /> PROJEC DESCRIPTION: ' <br /> / .s T.,. •_., .. r i <br /> ❑ 4* "e) . ,VI,,'"i6 W;It',/ 'This project is a new building or structure. y �i <br /> p"This project is an addition teration an existing building or structure. . <br /> SANITARY SERVICE: PERMIT NUMBE ' � / <br /> SEWER EPTIC x / ° $ fi <br /> HEIGHT IN FEET: / , NUMBER OF STORI!S: (Not including basement) ,, ,/ ,/ <br /> � t : ' s sus s I< , <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished ar a, attached garages and above grade decks or porches) <br /> s s ys ° r$ <br /> BASEMENT: <br /> 1ST FLOOR. <br /> TOTAL SQUARE FOOTAGE: + sI � <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: -a W 14�tt0 o <br /> (Please round to nearest dollar) $ g :,.-9,,,-, ,-, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑ No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the-property? s ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank N. none) <br /> 6. Is a location survey required? (see reverse) DYes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes KNo <br /> APPLICAU BE SIGD <br /> (Continue on TION Back)MST ♦ — NE <br /> ► <br /> 545-112(4/08) <br />