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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App# <br /> w <br /> PROPERTY OWNER,INFORMATION :,;;: .. z=_ ,'1 4, ,r, .: 4,L. ,- CUSTOMER TO PROVIDE <br /> OWNER NAME k( <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ Zoning Status;CUP; <br /> .2.c\v0 W V���1� (�, , ON V-0)-) Deed Restriction;CSM <br /> �`�" Variance(# ) <br /> HOME PHONE //p' CELL PHONE E-MAIL ADDRESS <br /> G 4' - 4601 68g-2 N''wkiwti1t - tic • (- r` ❑ Site Plan drawn to scale <br /> AGENT INFORMATION:;:: ;J CONTRACTOR'INFORMATION :?Y ; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> '--5-11-N hh..)S ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1-1,43 YM►S Ct+-kSTU)(114 a <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 .:(httpillaccesstlane.co.dane.wims/) ''' ❑ Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> P rtY <br /> ❑ PARCEL 3 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: <br /> cA SECTION: <br /> /1 ua Of `��T►r► 1/4; 1/1/: ❑ Driveway permits <br /> (state,county,town) <br /> W Ps•itask �4 , �RpSo,1 W % S3 1 N <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> Loz f .22 Rtocx3 <br /> PROPOSED PROJECT INFORMATION. `; , _ . T <br /> PROJECT D SCRIPTION: r v -` --- - <br /> 1 Mf$-ovk ' 'i -Ta Veek--i- Dc Loves Fcv... M ,:' <br /> ❑T is project is a new building or structure. 4 s �s <br /> I �fltrkg ;r ' <br /> This project is an addition/alteration to an existing building or structure. r,, ''t <br /> SANITARY SERVICE: PERMIT NUMBER: f a l} +. <br /> - , <br /> r <br /> ❑SEWER ❑SEPTIC A � y, , <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - <br /> AREA TO NEAREST SQUARE FOOT: <br /> ga° � � ; <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) -w <br /> BASEMENT: - 1 ST FLOOR: 3 4 ®����a ® 0 r 1 7 <br /> ,I, TOTAL SQUARE FOOTAGE: 4, m :t u. ° " ` <br /> 11 f <br /> Fg_I `1,fct.t� SOD�IL6GFk V'PYL-^"-- 14'4 _ .f'p'1j,1?�� d'(>? r-o'''sjls +a V•T s <br /> it' set •FT 9x3. (t+x?'� = 32c , 4A. 3a r- gS� ,- _,. <br /> ESTIMATED CONSTRUCTION COST: � �I �;b <br /> (Please round to nearest dollar) 4 ; ;; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? des ❑No ❑Don't know E <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 ❑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 /> (Continue on Back) -t —► —► <br /> 545-112(4/08) <br />