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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App# <br /> PROPERTY.OWNER;INFORMAT,IONc,.,;. , _ ,:'.' d „ot , ,..-:'< ,, .=#- '•; CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ch',t/LLES LU 6FI'c'L Hu 1 ,--- ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> `1,e0 ( 9 6 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> `7 / - `TQy7 66 ?-DS9'? ❑ Site Plan drawn to scale <br /> AGENT INFORMATION .' CONTRACTOR::INFORMATION x 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.co.dane.wi.usn; ❑ Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> ❑ PNAUMRCEL BER C7 c)- -302,cC3 _G A- (E)4. ` L. c frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> CSS 30 ,/: ,/,/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> • <br /> `t b N'"'te ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION, <br /> PROJECT DESCRIPTION: �_ � <br /> -61/4-21 L,j ,-J C= Goo r a -12 1872 4, 1 �� " ---:q` ` <br /> ❑This project is a new building or structure. It In' § ��' r-3sr. � <br /> ❑This project is an addition/alteration to an existing building or structure. 4. ' T <br /> Z '' <br /> SANITARY SERVICE: PERMIT NUMBER: :+ '� ' � °°�� '" c� <br /> ❑SEWER ❑SEPTIC :7 0� -a � ,< f k„ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> �� re" <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � s ,V <br /> BASEMENT: 1ST FLOOR: , e ° mke.,- <br /> 4, TOTAL SQUARE FOOTAGE: ,� �� aiY" <br /> 2ND FLOOR: 3RD FLOOR: ;fart s a,� <br /> ESTIMATED CONSTRUCTION COST: ib�2 fi- °t"` �� �', � <br /> �W <br /> (Please round to nearest dollar) - -4► "'0. '� � ® � �� <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 lallo <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) CI Yes •No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0-No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />