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Ilb <br /> • <br /> - - 1 11 = (J <br /> • ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / ( , <br /> l/ LOtU1 e c J ` dZoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,Cit,Statet,Zip) S ,-11\11_Deed Restriction;CSM <br /> P -L-d- �� Vv e( `�a-,5 6A- J Or( I tG Variance(# ) <br /> HOM PHONE Q CELL PHONE E-MAIL QRE S\ �q <br /> 7$ c j a- I " S C�� U Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> FA re Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip) Zip)(City,State,Zip l� Setbacks <br /> Y <br /> PHONE PHONE •cite Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane,co.dane.wi-us/) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P Y <br /> J PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTIO . <br /> 4). ,—e CC �1 ' 1/414: �' s Iveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> ary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW' <br /> PROJECT DESCRIPTIQM: } `je <br /> � -v"�" LL C,e' v `'A le re/ �t ( (�Sf oning I istrit <br /> This project is a new building or st) ture. Permitted Use°? <br /> ❑This e <br /> pro) ct is an addition/alteration to an existing building or structure. <br /> SANITARY SE VICE: PERMIT NUMBER: Rural ' r. <br /> LI SEWER ❑SEPTIC {new O") '- <br /> NUMBER 0=STORIES: (Not including basement) ' <br /> HEIGHT IN FEET:, at a (¢ <br /> X97 <br /> '1, t V•relaff attach lent,) <br /> AREA TO NEAREST SQUARE FOIT: i, <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1STFLOO <br /> 4, TOTAL SQUARE FOOTAGE: 4, � t . , <br /> 2ND FLOOR: 3RD FLOOR: / es ` <br /> � �0 ''� <br /> ZI '*aw Location 5-y- <br /> ESTIMATED CONSTRUCTION COST: "" 5 <br /> and available t.n5-. <br /> (Please round to nearest dollar) "∎ -� "� ""I. -+ -* $ 5'G q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes 0 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? A Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your projec and are they in agreement'? ❑Yes " No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ititNo <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) Ayes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 040 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -♦ -► <br /> 545-112(4/08) <br />