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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER,.INFORMATION`: CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> V o-DE LL c ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> (Q eoi 5'0 O-puN>' eyv2fi 41G n!WI 5.3-7)3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /4 rte,. ,-3)ol ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> V ---e< j - L-L C ❑ Site Plan including location . <br /> AGENT ADDRESS CO CTOR ADDRESS l <br /> NT . of well/septic <br /> ,¢)CIS 4-061,--- <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE i ❑ Site Plan approval from <br /> 40, Q r —ao-(o---3 ) 0 o applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danewLus/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> 0 PARCEL 07/6 1,213 1 o <br /> NUMBER ,03 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /<. %1/4: ❑ Driveway permits <br /> ADDRESS: 1ri� (state,county,town) <br /> I fe W' " ❑ Sanitary permits <br /> CSM: LOTA // SUBDIVISION , <br /> a I Q .2 (public,private) <br /> PROPOSED PROJECT INFORMATION : 7 <br /> � p <br /> PROJECT DESCRIPTION; s � ",< <br /> Af / n / y <br /> . =4 This project is a new building or structure. i P � ' ® -`� _ <br /> ❑This project is an addition/alteration to an existing building or structure. -,....,,--n,,,,_:<-':,4*- -,,-1!1 <br /> SANITARY SERVICE: PERMIT N R- '",,,k0.29:w -v: °° <br /> SEWER ❑SEPTIC / ,a a <br /> y i-4T- `r-� ; <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) s k <br /> -x <br /> AREA TO NEAREST SQUARE FOOT: b a �? � �_'. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)F,' if r � : <br /> BASEMENT: '�� 1ST FLOOR: i ., a",e�' �e ? <br /> I j pi 1 I� TOTAL SQUARE FOOTAGE: S ®'=° a �'�,. <br /> 2ND FLOOR: 3RD FLOOR: _ <br /> Or cir <br /> ESTIMATED CONSTRUCTION COST: DO k , <br /> (Please round to nearest dollar) '� ♦ ♦ ♦ "� ♦ /4/0/0(0 trz �� n ° # <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Il'No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes t'No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes 2No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [i-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) l Yes ❑No LI Don't know <br /> 7. Is this to correct a violation? ❑Yes -3-No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —' —■. <br /> 545-112(4/08) <br />