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ZONING PERMIT APPLICATION ww.countyofdane.con1 ;SUPPLEMENT to,Web_App#_ <br /> w <br /> PROPERTY OWNER INFORMATION . ;;.: ...•: . . CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> S.l - n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> a 82CO � > S% Deed Restriction; CSM ) <br /> Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 62/. SV9 0 S C,,tiZ ❑Site Plan drawn to scale <br /> AGENT'INFORMATIOh1 CONTRACTOR INFORMATION_ _ ,` and includes dimensions <br /> AGE AME CONT TOR NAME <br /> � z,—- ,� (t,\-4 C ' ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTORAD'DRESS of well/septic <br /> L030(0 —S } d> S Cc...,— <br /> (city,State,Zip) / (City,State,Zip) ❑ Setbacks <br /> f3� (I•�L' 1 (4. , • <br /> PHONE PHONE ❑ Site Plan approval from <br /> (pc 6" c� S- 0 2_. S 4 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> I i✓ �-cJ,�c,h{y, . ...-•-e ❑ Floor plans to scale <br /> `PROPERTY/LOCATION,;INFORMATION_ °(http el/accessdaneco.dane.vvi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ON G: ACREAGE: <br /> ❑PARCEL f_ q)l( frontage drawn to scale. <br /> NUMBER • <br /> TOWNSHIP: - SECTION: <br /> •-7 (.4.A4_, N�.,���, ,/: ,/4,/4: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> d po BB, C,,," sr <br /> CSM: LOT SUBDIVISION BL T ❑Sanitary permits <br /> • ® i )001 8 (public, private) <br /> PROPOSED PROJECT INFORMATION - l�'•PROJECT DESCRIPTION: ='t E STAFIt`'Rf iE11V i <br /> 0t©o S7. VY)o-,d � wt S � 1 1 l ky ning Dlsfr�dt �' . <br /> ❑This project is a new building or structure. ! �_ s <br /> p J 9 Permitted UseU 2- <br /> this project is an addition/alteration to an existing building or structure. 4.`1 -t <br /> R r_al Address -g- . ' <br /> SANITARY SERVICE: PERMIT NUMBER: t-��r.,r ,�z �,�,,,,a���.3��i z 3� r <br /> . EWER EPTIC =tnalvexlSg� trc <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) 1"`� £' "�' '-` <br /> / ( (9 Q Wetlari /Floadpla of <br /> -== t IOs land attaic'trhept) - <br /> AREA TO NEAREST SQUARE FOOT li `�r' -i M I � �- <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) }vi- -�, �- e r �. <br /> BASFJutENT 1ST FLOOR: �E{osiCo'rlrpermlt {: <br /> J�� -J 207T/J g – 1 TOTAL SQUARE FOOTAGE 1 s ` <br /> cs ' <br /> 2ND FLOOR: 3RD FLOOR: �c ' ,toga .mac <br /> 5 . <br /> 5O .iiO4t iocatt n u ey <br /> ESTIMATED CONSTRUCTION COST: / <br /> (Please found to nearest dollar) '� ♦ �� ��(�✓" �`"� r.l' �j X5 1. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes , ']No • fDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies No .['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ' Yes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves 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) Des inNo ❑Don't know <br /> 7. Is this to correct a violation? [yes ' lo . <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -4 <br /> 545-112{4/08) . <br />