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1 ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /9//1(-6.- D ' P`' <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /�� Zoning Status;CUP; <br /> eed Restriction;CSM <br /> ?3 9 Ain dam'6, RI Variance(# ) <br /> HOME PHONE CELL PHONE' E-MAIL ADDRESS <br /> 619'-,E3 9 ?-'7f .' P ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME /.--.c CONTRACTOR NAME <br /> . —74rrtplo,? Wo'141o4.) of d,`S6r2 5q'7-7 a Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • well/septic <br /> S3 Z( (/o_geS Same <br /> (City,State,Zip) (City,State,Zip) i Setbacks <br /> cY s G.? GU-2---- 537/8 Sam e <br /> PHONE PHONE I e Plan approval from <br /> .08-838-6y00 5 .?-2e_ , •p'cable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> • loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danemi.us/) levation of property <br /> PARENT PARCEL NUMBER: CUR T ZQNING: ACREA P P y <br /> NUMBER =�j Q 3�'� 3 f C ( '�( 3 o .ge drawn to scale. <br /> TOWNSHIP:.%1 SECTION: <br /> V ,� v∎v.r °� G '/a: 5 '/a'/a i J <br /> El Drive per■ its <br /> ADDRESS ,� <br /> st. ,co. ty,town) <br /> 1 `a, <br /> '.. r" )� ❑ Sanita , -rmits <br /> CSM: LOT SUBDIVISIO BLOC •T (public,p ate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: Al S-e C� fling <br /> ❑This project is a new building or structure. ermined ? <br /> • his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NU B ° s-{ <br /> 4 <br /> ❑SEWER ,EPTIC _ � <br /> I <br /> HEIGHT IN FEET: 1 I NUMBER OF TIES: (Not including basement) <br /> a oral. i <br /> Sf • a nt) `. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , <br /> BASEMENT 1ST FLOO t e €'. :;.7.:6'4.,s. <br /> 11 L l TOTAL SQUARE FOOTAGE: •1 ,6 w 'E� s r 3 <br /> 2ND FLOOR: 3RD FLOOR: <br /> '2k( '--- 14 ivi <br /> eVieW e. •nrey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) $ -� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ∎' No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes N o ❑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 o <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 lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes �o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -+ ■ —► <br />