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ZONING PERMIT APPLICATION .countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER T• - -OVIDE <br /> OWNER NAME _ <br /> OWN R ADDRESS (Number,Street,City,Stat Zip) ❑ Zonin. : atus; CUP; <br /> S � S 5,,, �r�.�- L,72 D::• Restriction;_CSM <br /> HOME PHONE Z� CELL PHONE 23 I E-MAILAD��RESS V.riance(# ) <br /> It Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRAC OR NAME <br /> to Plan including location <br /> AGENT ADD CONTRAC OR ADDRESS ?fl well/septic <br /> (City,State,zip) rvA ,E (City,State,Zip) 0 Setbacks <br /> PHONE PHONE ❑ Site Plan.appfoval from <br /> applicable toship. <br /> E-MAILADDRESS E-MAIL AD n RESS <br /> ❑ loorrilans to scale <br /> " <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi-us/) E vation of property <br /> PARENT PAR EL MBER: RENT'.NING: ACREAGE: P P rty <br /> ❑ PARCEL 0�(( 0��-. > 7�0 - I�_ ' S O r f ontage drawn to scale. <br /> NUMBER l <br /> TOWNSHIP: SE TION (� <br /> r I s '-k ( 1/4:S t-- 1/a 14: N E Dr veway permits <br /> ADDR s: i ( tate,county,town)y Sanitary permits <br /> CSM: S,cog Q) LOT 1 SUBDIVISI•N BLOCK/LOT (publi private) <br /> PROPOSED PROJECT INFORMATION <br /> FF REVIEW <br /> PROJECT DESCRIPTION: a <br /> �� Pi 1 � 0 its Dxsi'r 1. <br /> 0 his project is a new building or structure. <br /> Li errnitted Lfse? <br /> c:ii <br /> This project is an additio Iteration to an existing .uilding or structure. <br /> SANITARY SERVICE: PERMIT NU BER: Li Ru Ti .O ,, <br /> ❑SEWER SEPTIC _ (tie /existing) <br /> •HEIGHT IN FEET: g ( <br /> / NUMBER 0 STORIES: (Not including basement) <br /> ❑ YYWrtlattII 4 a&4)c 1® �> <br /> .Shur .. 1 ( hfent) <br /> AREA TO NEAREST SQUAR: FOOT: <br /> (Outside dimensions including unfinished area, attached gara!es and above grade decks or porches) <br /> ❑�1'�'Slf3i7 e:,, , s�a t 4 <br /> BASEMENT: 1ST FLOOR: 7/ (...) p p i ' ' . ,,l TOTAL SQUARE FOOTAGE: 4, #��� tS � <br /> 2ND FLOOR: 3RD FLOOR: (� (0 �! <br /> I7 I/ '�fl !' � <br /> ESTIMATED CONSTRUCTION COST: ( Revieeu tic 4r -ey^ <br /> (Please round to nearest dollar) ♦ ♦ ♦ "♦ 1 I ��Q i"�� <br /> 1. The property is within 300 feet of a stream or 1000 fret from a pond or lake? ❑Yes 0 fpt'o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the prope , ? ❑Yes D No ❑Don't know <br /> 3. Have you talked with the township about your projec and are they in agreement? Li Yes CI No <br /> 4. Has there been a zoning permit issued for this prope yin the past 5 years? ❑Yes El No <br /> 5. Is this project associated with a rezone/CUP/varianc: (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> I ( + APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —■ —r•► —► <br />