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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO P• •VIDE <br /> OWNER NAME <br /> ' � o /J GL C� {`� S-hA �-, CI Zoning us;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zi D I I _ <br /> 1U 3� 'l '-�` l ( 'lie, -� V. ance(#fiction; CSM <br /> HOME ONE �lL�"\ v CELL PHONE E-MAIL ADDRESS <br /> ( ) <br /> [[__�iII . to Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd i cludes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S. a Plan including location <br /> AGENT ADDRESS. CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) Set acks <br /> PHONE PHONE ❑ S. a Pla pproval from <br /> p'c le township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of pro pert <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P <br /> ❑ PARCEL 090/�75� -13�{-R93 -7 /4-1 C —x o (DC frontage drawn scale. <br /> TOWNSHIP: SECTION: <br /> PA O-Yt-r(L°S � ) 3 t/4: 5 e 141/4: �(AtJ ❑ Drivewa ermits <br /> ADDRESS: <br /> (stat ,county, •, n) <br /> 361 .2 Le--U; 1� �,� s 3 SIR- CI Sanita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu ,private) <br /> PROPOSED PROJECT INFORMATION <br /> TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /�1 Y al-I ,,f D a 1 , I rffrng District <br /> 1 <br /> is project is a new building or structure.2C Permitted Uses <br /> This project is an additio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Ru <br /> ❑SEWER SEPTIC Me /exist' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetted', oodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoe and {a d,' ent) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) - <br /> BASEMENT: 1ST FLOOR: � �rl�l;�I�#� • � � � � <br /> 4, TOTAL SQUARE FOOTAGE: j y(5 • i71�� • <br /> i I i,f-�sss) z <br /> 2ND FLOOR: 3RD FLOOR: `!'CJ•� <br /> ESTIMATED CONSTRUCTION COST: 1 R2vIeW(„{Cat otituniey <br /> (Please round to nearest dollar) "� '� '� 0 0 !�, and r7YallC' 35{QnS <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'gNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes V No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ElYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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 'No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ ■ —► <br />