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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 /> ` i1 E_i • i A. ning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State, , ' ` !Deed Restriction;CSM <br /> 133 CV, ♦ CA E_ ar l 1 ` l�J ■ 53534 Variance(# ) <br /> HOME ADDRESS <br /> A ,�. ,1 I , -..A ,• 1 I ♦ ' i -el = 1 .1, „, !' Iv Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS ../.' CONTRACTOR ESS of well/septic <br /> (City,State,Zip) 4• (City,State,Zip) f\ 'etbacks <br /> PHONE ./ PHONE D Site royal from <br /> //// ab township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> f rloor plans t scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdar,e.ca.dane.wi.us!) <br /> PARENT PARCEL NUMBER: CURRENT Z«NING: ACREAGE: n Elevation of property <br /> L3 N MBER CO051'1-2-51 �5igt'in .R 4 . y s frontage drawn to scale. <br /> TOWNSHIP: ^ SECTION: 14:S • 1 •5 Driv- ay p: its <br /> (u\ ` -1 /a/a. ' state «•..nty,town) <br /> ADDRESS: <br /> J ` 0 ► ', 41_ I_l t' tr)I A ■∎I San! - ■ p- ''- <br /> CSM: LOT v UBDIVISION BLOCK/UT <br /> r (public ywate) <br /> . aA <br /> PROPOSED PROJECT INFORMATION F JEW <br /> PROJECT DESCRIPTION: ^ . _� rr> CAA() 'Zoning Dis <br /> ❑This project is a new building or structure. ,Permitted Use? <br /> Cif This project is an addition/alteration to an existing building or structure. <br /> . <br /> SANITARY SERVICE: PERMIT NUMBER: V . if,I �._,', <br /> SEWER CI SEPTIC i1 T <br /> yam*, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - ;.y <br /> 10— S 1 � w cr . : H orelar f,: a 3oi <br /> --(' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> fi x.-• :. <br /> j, TOTAL SQUARE FOOTAGE: g � ti K, <br /> -Lu ©Q <br /> ' 2 <br /> 2ND FLOOR: 3RD FLOOR �"'�7� Q / ,„ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ 0 ` - ..a . .' e,; <br /> (Please round to nearest dollar) $ 3 5 , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes a No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes tNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Z1 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 la No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes INo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► • -+ <br /> 545-112(4/08) <br />