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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App# <br /> PROPERTY OWNER INFORMATION .:; ,__ ' .%1 A4iy-p %.•- ::-.,'-',•,;-::! ;-`;':-."-1'.; CUSTOMER TO PROVIDE <br /> OWNER NAME ._ <br /> .-,e,,,k.„ --k, . <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> / 71a Al.. - - is .d-3se? Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> h'*-8-73-.5-7.? A.- 3 —11,69% ❑ Site Plan drawn to scale <br /> AGENT INFORMATION - 2. CONTRACTOR INFORMATION' , .P.•`-,:;:.,-,' and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> • <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://accessdane.co.danewi.usl) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: /) CURRENT ZONING: ACREAGE: P P rtY <br /> ❑ <br /> N PARCEL UMBER t:�S��f—�f� E3 s--7 7 '7 4-)-e---i _ / c--- 7L frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 'Ar11'1 kvi ( 1/: /x NI 1/1/4. A)fr,/ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 17 IC 1 .0,45-.e.._ i ❑ Sanitary permits <br /> CSM: LOT — SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION, ' ' TAB <br /> PROJECT DESCRIPTION: + K <br /> This project is a new building or structure. � � <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> - m <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> pritlib.*464t11----;:, <br /> ❑SEWER 4 SEPTIC //^ * I qqa <br /> - <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) 1, ,' <br /> ( <br /> s i€ i. <br /> AREA TO NEAREST SQUARE FOOT: <br /> rg <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) riZiegri:: :1',,T:VV,!.-r--A� 1--,t41 <br /> e� �qa e <br /> BASEMENT: 1ST FLOOR: . <br /> 4, TOTAL SQUARE FOOTAGE: j, <br /> e <br /> e a <br /> 2ND FLOOR: Lit ea E <br /> . <br /> `ESTIMATED CONSTRUCTION COST: ...• .4. — -e = <br /> (Please round to nearest dollar) <br /> , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes LI 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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -► -∎ <br />