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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> th/< %' X74 /�. <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ Zoning Status;CUP; <br /> /5-Z.44GL,/./ S T>Y2 *-ei4�6. 7"/, L&, ,5,389' Deed Restriction;CSM <br /> HOME PHONE CELL PHONE Variance(# ) <br /> E-MAIL ADDRESS <br /> /— =z--9a'-.Z393 re..5 I h o k /i'o w'e9 r t 1. co,-.. <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> t ��s0,26 ;� -4 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> a/50X 2,9`71- s„6 ,4 <br /> (City'State,Zip) (City,State,Zip) ❑ Setbacks <br /> Care6‘6zet4i �. 535Z2- <br /> PHONE PHONE ❑ Site Plan approval from <br /> ' 95- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> c'.0 /e_ ZD/CG►YL ■+ <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL Oryek/Ah//�� 6359 S , <br /> NUMBER frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> frGie 0'T c#P2mei< 1/: 5,g %I/4: it& ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2575-Gt%44'4 Ti's <br /> CSM: LOT SUBDIVISION �, BLOCK/LOT ❑ Sanitary permits <br /> // l7/14- (public,private) <br /> PROPOSED PROJECT INFORMATION -.:, 7- <br /> PROJECT DESCRIPTION: ' � z�' <br /> / x �J' �/T/ON/4/sfit//6?7, 1/ //G;2b' a— , & fait <br /> • ❑This project is a new building or structure. � � <br /> This project is an addition/alteration to an existing building or structure. �` - ,4 <br /> -:� <br /> SANITARY SERVICE: PERMIT NUMBER: �, "°'`4 <br /> nSEWER SEPTIC w F* fi. . . �. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ` # :• . y e z <br /> /e=�i i/ :°,gam 4- f <br /> e. zip : <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - �' i' <br /> BASEMENT 1ST FLOOR: a $ :€ <br /> y 4 . � R <br /> G ' �, TOTAL SQUARE FOOTAGE: 4 �� <br /> 2ND FLOOR: 3RD FLOOR: ,�/� a 1' �. <br /> — - ZIP& //e X i4.44 k p <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ —► ""► '-0. —► $ &O�r,,�-� �s' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®No El Don't know <br /> 2. Is there a wetland or floodplain on or near the property? El Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 0 Yes El No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0 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 2 N ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes JNo <br /> • <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -♦ <br />