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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App# <br /> PROPERTY OWNER INFORMATION Y, . __ 0," ith , ,, , �< -< t!;'-* € <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Is rIL <br /> /WNERADDRESS (Number,Street City,State,Zip) Illi oning Status;CUP; <br /> _—� .71 G0uN j� c-20.00k. ii oeG(E 0 I CcE 1,..)1 635/.6 Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> L/Zt— 14160 333 /°(.'3 ci z.s i=€ m'6-"' ""`"- `O 0 1 ite Plan drawn to scale <br /> AGENT INFORMATION ; CONTRACTOR INFORMATION , _, -; - d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> `, ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) IN etbacks <br /> PHONE PHONE \ Site Plan approval from <br /> -pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION;'::(http:l/accessdane.co dane.wi.usn ►_� evation of property <br /> PARENT PARCEL NUMBER: CURRE TZ,qNIN ACREAGE: p P rtY <br /> ❑ NUM ER S o ) � 5 S I 1 D` — 8 . 0 I 6 ontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> fA/I oAc ra-c>SE y: SE ,A,/: )'J II Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ' Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION. t . T 7--- ,:::,..,k, „ <br /> PROJECT DESCRIPTION: F z. - 4� <br /> 0-This project is a new building or structure. , F ;€ <br /> ❑This project is an addition/alteration to an existing building or structure. ' <br /> SANITARY SERVICE: <br /> 0� PERMIT NU - '. ��r� ect4� �<� <br /> ❑SEWER ❑SEPTIC Q\) : �VV .fV S " <br /> HEIGHT IN FEET: V NUMBER OF STORIES' (Not including basement) �'' �, <br /> MI <br /> i <br /> ® . .. VV <br /> AREA TO NEAREST SQUARE FOOT: P <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4 <br /> 1 <br /> BASEMENT: 1ST FLOOR: j e ,:. 1.' . P <br /> t� 4, TOTAL SQUARE FOOTAGE: � ,-, ' <br /> 2ND FLOOR: 3RD FLOOR: <br /> j, i t�' 44'7;71 <br /> s5 <br /> ESTIMATED CONSTRUCTION COST: �� - <br /> (Please round to nearest dollar) "'0' -4► --► "� -4. "'∎ $ /8/ toc? � ` � '� V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,reiitNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes giNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ;St 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 KNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> sas I12(4/08) (Continue on Back) —► —► —► <br /> ( ) <br />