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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION t ., _ ! A i.t ' .1 <br /> CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 'v)'b f >\itil l[ `-AE: 3E L_ ❑ Zoning Status;CUP; <br /> OWN RADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> -260 6S go_.-t- /L) ii 7 /,ti. /2 , Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 73- /&93 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION>-;:; CONTRACTOR INFORMATION ;? ,_ ; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> D�/Y/l�%� ��iv`S�'�aL;�oi� 2144A �. rcJ 7Ox./ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 023.3 14J)L-/em5 -)ii , ,:4-71/C-- <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 5,--ea G- - w �/l/, , 5356.9 5-/-n E <br /> PHONE PHONE ❑ Site Plan approval from <br /> ©r c'3 35 o ..45-ne applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> OCJ , ,R36. I1,,4iicip•Co,-7 .5". rn - ❑ Floor plans to scale <br /> PROPERTY/LOCATION'INFORMATION" ;(http:llacceasdane.co.dane.wi.usn ❑ Elevation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P rtY <br /> © �� i` ' Zgl" )fig- 7 ,��UM ER l'(//3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /7 S Sp/g///a s a.? 1A: /Jt W : AE ❑ Driveway permits <br /> AD RESS: / (state,county,town) <br /> 02�8'5. i i- ,A/G 1/'iEiv gd ''// / ❑ Sanitary permits <br /> CSM: LOT SUBDIVISIONba ti'�� :LOCK/LOT <br /> / (public,private) <br /> 4ei. 5/uiQ.t <br /> PROPOSED PROJECT INFORMATION. ;r <br /> PROJECT DESCRIPTION: /915P/770 i ` ,' <br /> V/�G ,�.� _ 1 A L t y , <br /> ❑This project is a new building or structure. �� w <br /> • .This project is an addition/alteration to an existing building or structure. . _ ,nab <br /> SANITARY SERVICE: PERMIT NUMBER: � kc. 'i_, ... <br /> ❑SEWER SEPTIC 07 � <br /> HEIGHT IN FEET: /n . NUMBER OF STORIES: (Not including basement) }7 ': <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '� st1 <br /> ,,: 1 <br /> BASEMENT: 1ST FLOOR: 1 ;74":727„7:, i ` <br /> 92 v V �QeQ TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: V 3RD FLOOR:VV VV 2 } - � , ' � <br /> ESTIMATED CONSTRUCTION COST: o ,®-- <br /> (Please round to nearest dollar) "* "� ' c ' ; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? des ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 15.4,Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Ei 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 13No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -0 <br /> 545-112(4/08) <br />