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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER,:INFORMATIONa = ,'. �'" ' i :��,�, :;, a. . `, :_�j <br /> w' CUSTOMER TO PROVIDE <br /> OWNER NAME _ �/a �. , <br /> , /'9q S - ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 229 �pfig //li/�i�1 e46Ac 6; Deed Restriction;CSM <br /> / �✓" V----.� Variance(# ) <br /> HOME P ONE CELL PHONE E-MAIL ADDRESS <br /> tdi• '�S-3�Q ❑ Site Plan drawn to scale <br /> AGENT INFORMATION. .: CONTRACTORJNFORMATION ? s and includes dimensions <br /> AGENT NAME CONT CTOR NAME <br /> T/d4/C-«y/f�p� ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ( of well/septic <br /> foe 23 fi <br /> (City,State,Zip) (City,Stat ,Zip) .r LI Setbacks <br /> Goira Grvc�C �t,u..,f..3.f2 <br /> PHONE PHONE V ' 7 ❑ Site Plan approval from <br /> 670g %.1--ZS b 9,p 5—' applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION':(http:l/accessdane.co.dane.wi.usl) <br /> (PARENT PARCEL NUMBER: <br /> ,r CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ^NUMBER /—/T -70714-6 /21"/- / 2,3 frontage drawn to scale. <br /> TOWNSHIP: SECTION,: <br /> / l/Q ar) / ,/4. .j� 1/1/:.5' ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM:t'� e� y LOT SUBDIVISION BLOCK/LOT <br /> f..03 2 (public,private) <br /> PROPOSED PROJECT INFORMATION.! , ' e - A <br /> � '- ' <br /> PROJECT DESCRIPTION: ) ,£ z � <br /> �,` ' �y yi <br /> • his project is a new building or structure. a l <br /> LI This project is an addition/alteration to an existing building or structure. - : <br /> SANITARY SERVICE: PERMIT NUMBER- f' I ". °a , .',...;,;`:',74-1 <br /> ? <br /> O SEWER ♦I• SEPTIC / e 21 `'1 —, .. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 1 -€ -, v <br /> Tyr <br /> AREA TO NEAREST SQUARE FOOT: a; ,7 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' <br /> BASEMENT: 1ST FLOOR: 7- ® ' @V , --.;. <br /> //J / /)2 1 ,, TOTAL SQUARE FOOTAGE: ,, r a� �. ) t €: <br /> 2ND FLO R: / 3RD FLOOR: E � <br /> ESTIMATED CONSTRUCTION COST / ', 4c- <br /> ( ) - -+ -- -► -► -+ $ 00 :e ge:,_ <br /> Please round to nearest dollar � � G/ � �:�... �' -,, �� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Cgplo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeso LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? des ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI 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 (NNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes `grNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -i <br /> 545-112(4/08) <br />