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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web�App# <br /> PROPERTY OWNER:.INFORMATION z,;„ ;'.; id' _a._-':, ==,,;; f. 1, _ CUSTOMER TO P VIDE <br /> OWNER NAME G `ri_ ���s dY1 <br /> ' , ` ❑ Zoning Sta s;CUP; <br /> OWNER ADDRESS (Number,Street,CU,State,Zip) n <br /> (9516 Cross l�v,-nki” 9- ' Deed triction;CSM <br /> ari ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 11L —i 515 (kV 'il-i1-1.—i S fS ' 5s (tSA-&-ra rVloi aSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION. and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,�-1■Q Swa-►-N.-12._ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDR S 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:l/accessdane.co.dane.wi.usl) <br /> PARENT PARCEL MBER:* A CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ N <br /> NUMBER oG iiJ -T l —d R� ' ,;. it., . = frontage drawn to scale. <br /> TOWNSHIP: SECTION: 0) / filA1 <br /> Li 1/ 1/4: ,/,/: ❑ Driveway permits �1/ <br /> ADDRESS:/` T7�� CO3,,,4-,in, �_n (state,county,town) ro <br /> 6 1 D (f'o`25 gC v � 5-3 5—`(.5 <br /> ❑ Sanitary permits <br /> CSM: ���� LOT SUBDIVISION BLOCK/LOT (public,private) "��) <br /> 1 • ile <br /> PROPOSED PROJECT INFORMATION. <br /> : .0714:1::'''.:7: <br /> .. ' <br /> PROJECT DESCRIPTION: a <br /> . .k 4cQc i-ItvTh t i` t , e G 2 e• p ® 5 , <br /> CI This project is a new building or struc re. : <br /> This project is an addition/alteration to an existing building or structure. <br /> ` #: _ S <br /> SANITARY SERVICE: PERMIT NUMBER: .F*,-a� . ` <br /> z <br /> ❑SEWER L SEPTIC f � �� � _ <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ` ' 1: <br /> qd T' e,4 F s air i ?g r :.,. <br /> AREA TO NEAREST SQUARE FOOT: j <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' <br /> BASEMENT 1ST FLOOR: ® �� ®� <br /> °3� ,_ ' m°: � f 0 <br /> 2.16-0 f(� ,, TOTAL SQUARE FOOTAGE: j a u <br /> ° v` <br /> 2ND FLOOR: ��� 3RD FLOOR: �) <br /> ESTIMATED CONSTRUCTION COST: <br /> p o aa8e <br /> (Please round to nearest dollar) ♦ ♦ ♦ "� "♦ 17 , � ; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 51No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes jallo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 'No h - 't�cu.Nckci_eu, <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? xl 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 0 N <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -∎ <br /> 545-112(4/08) <br />