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ZONING PERMIT APPLICATION w.countyofdane.com 4SUPPLEMENT to Web App,# <br /> ww <br /> 1PROPERTY OWNER"INFORMATIOPM 4,4-e 0 Y ? r -' CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �X.Q.,► 1p`-3 • • <br /> Status; CUP; <br /> OWNER ADDRESS (Number, t,C <br /> e <br /> Streity,State,Zip) <br /> 495.\-\ t D _ Deed Restriction;\CSM <br /> ` rww-I 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS - <br /> S \Z y15Cw 11 Site Plan drawn to scale <br /> AGENT(INFORMA_TIONI - , y,;; M�CONTIACTOtt"INFORIMgT10N_ _,-n ; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑Site Pl val from <br /> - pplica I wnship. <br /> E-MAILADDRESS E-MAIL ADDRESS - <br /> Floor plans to scale <br /> `PROPRRTYILOCATION 7NFo MATION> (httpe//acces5iiane,cO,dane*us/) 'Elevation of ro e <br /> PARENT PARCEL NUMBER: CURRENT-ZONING: ACREAGE: property <br /> ❑PARCEL �q • frontage drawn to scale. <br /> NUMBER v 101-11�� 7-� A1-�� 1Ct) <br /> ::::: SECTION: 1/4: ,/4,/4.�� (sta ty, town) <br /> - ❑CSM: LOT SUBDIVISION BLOCK/LOT (pub pte) <br /> - <br /> Q 'ST ARV <br /> PROPOSED PROJECT_INFORMATION..'; �_ A �-�- <br /> PROJECT DESCRIPTION: � w [ - 14, Y••-p { <br /> �D �tSCLI N Coo) �: <br /> y� O ra 1 p/� <br /> • �This project is a new building or-structure. • I` " F ' ' <br /> P 1 9� g��erinlif�ed�Js A � -, <br /> This project is an addition/alteration to an existing building or structure. `k_a 6 t -� fr �Q- - <br /> SANITARY SERVICE PERMIT NUMBER: " a a"e t , <br /> . EEWER - EPT1C _ 4r � '' 'it <br /> HEIGHT IN FEET NUMBER OF STORIES; (Not including basement) -— .,- 7`0 , EYe e .F.I Ioc • 11. ° fil-; <br /> AREA TO NEAREST SQUARE FOOT: . 3-� - C's" °' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) -1 + a *, <br /> BASEMENT 1ST FLOOR: ` .p .- ' -- r e-- t. <br /> - 4, TOTAL SQUARE FOOTAGE. ,j, t. 5>3°� $ ,�-sC ' <br /> �T <br /> 2ND FLOOR: 3RD FLOOR 1 -_ .,..� - <br /> ESTIMATED CONSTRUCTION COST: ' Ea " <br /> -i -F_ E-1-";P.1 RTE <br /> (Please round to nearest dollar) —I- '♦ --► --► "! -0. 0 t D��b �x�' R� _ { <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LYes ' ONo-• aDon't-know <br /> 2. Is there a wetland or floodplain on or near the property? QYes END .ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? fYes ❑No. ' <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? QYes ONO : . <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 ONo ' ['Don't know <br /> 7. Is this to correct a violation? V QYes ON . <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -4 -4- <br /> 645-112{4roe) - <br />