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• <br /> •ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> t "c'& }-1'v()�1412—' ❑ Zoning Stat , UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed R riction; CSM <br /> 4748 EMe-H Mt r D vAt y RD, i i 00tt-7ui, 144z. 5-3542- a . ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ?re-.2z 47 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �uy41/0 15,41DCOCK a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 1705 4..)450mAxtio 6r, <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> N4,- go•esih , 53 572_ <br /> PHONE PHONE ❑ S e Pla pproval from <br /> 608) 44?-35g4 ppl. ble township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> i :' cc< or &N41 - ,GEIVX FFioor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ ,I levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: `/ <br /> ❑ PARCEL 038/0?08_OLZ'87eo , RH --Z 4 •`I frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SEo N: <br /> / f P64ErVN /: N KJ '/'/a: N INJ ❑ DCIV @Wa rmits <br /> (state ounty,tow ) <br /> ADDRESS: <br /> 474e g yµvreD v-Aua rzt /It/iDalerw.+ , 4.a1 53562- ❑ Sanitary its <br /> CSM: n LOT 3 SUBDIVISION BLOCK/LOT (publi , rivate) <br /> PROPOSED PROJECT INFORMATION , <br /> NFORMATION TAFF REVIEW .. <br /> PROJECT DESCRIPTION: ':� f <br /> 3 cil-,- 4 ,art0E— Qg .>e___3 -,,a a Ing District 4 <br /> 1 <br /> . aThis project is a new building or structure. sermitte• <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural S ` <br /> (rnew iS • '1 a <br /> ❑SEWER W SEPTIC ``� �� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 ❑ Wetian , oodplainf x <br /> Sho and (attach 1 eni) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> v ❑ � a" I rosionE+ $ permit p <br /> BASEMENT: 1., ? " 1ST FLOOR: 0 , TOTAL SQUARE FOOTAGE: ` (,,,,9134-:„,..';'!,10444:0464-0 <br /> (Ii: Bess + <br /> 4 <br /> 2ND FLOOR: 20 3RD FLOOR: �f � <br /> ,�� P�Q i / V <br /> k Review Locations Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ —! DOO, °O and ava"tlabCe 0(3tlQ[ls <br /> (Please round to nearest dollar) ✓ / :. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes Ca No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes il No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? wYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes O 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) 4 Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes A No <br /> APPLICATION MUST BE SIGNED <br /> CO (Continue on Back) –► –► –► <br /> 545-112(4/08) <br />