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ZONING PERMIT APPLICATION www.countyofdane.com ;SUPPLEMENT to Web-App# <br /> PROPERTY OWNER:.INFORMATION� __':' .. -','f3:.47...M. ,V;# a._ ':' ._,- CUSTOMER TO PROVIDE <br /> OWNEA NAME <br /> / <br /> ' ` k' rif ' E E� ❑ Zonin Status;CUP <br /> �/ 9 <br /> OWNER ADDRESS (Number, City,State,Zip) ( /�� Deed Restriction;CSM <br /> ,. $ a$ i✓ f R KA Ai ,S.r /� fiv l�r�lj VI 3-2 7l/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> GO ' - .2.2-9 • 1 SS`i-'d , ❑ Site Plan drawn to scale <br /> AGENT INFORMATION.;::, - , CONTRACTOR INFORMATION:," and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION ' (http:1/accessdane.ca4ane.wi.usl) ' <br /> ❑PARENT P 0 CELNUMBER: CURRENT ZONING: ACREAGE: Elevation of property rty <br /> ❑ � frontage drawn to scale. <br /> le. <br /> NUMBER 610 `d 2.2—� , f _ j 13 s--TOWNSHIP: <br /> C ION: <br /> CO IN ni 1A. ►V Vi I ,%,A: .5 ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ..,--"E' . E/?Kii,41/ 1— .13044 ID D Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PI4/ 1, <br /> PROPOSED PROJECT INFORMATION; r - ` ia - <br /> � <br /> PROJECT DESCRIPTION: r....;?'- r ' = - <br /> ❑This project is a new building or structure. ,f£ 6 �e't" ' <br /> • his project is an addition/alteration to an existing building or structure. r,2:..:: :k <br /> SANITARY SERVICE: PERMIT NUMBER: # `1 0'°°r"' - <br /> ❑SEWER ❑SEPTIC X IFY..d P"( <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) a <br /> -9 t / € P <br /> , -nl®' , tai y . i <br /> AREA TO NEAREST SQUARE FOOT: f <br /> (Outside dimensions including unfinished area,attached garage. and above grade decks or porches) �a, : <br /> BASEMENT: 1ST FLOOR: °a 1,1-4&521 R� K7•f `` <br /> if 4, TOTAL SQUARE FOOTAGE: 4, ; t e` m k, - , <br /> 2ND FLOOR: 3RD FLOOR: F <br /> ESTIMATED CONSTRUCTION COST: E.s® /, <br /> c f =(Please round to nearest dollar) --► —∎ --0. —► — --` $ � Q 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? i.E Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes 111,4o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Lo'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes CQ14o <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) F Yes ❑No d Don't know <br /> 7. Is this to correct a violation? ErYes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />