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• <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER.INFORMATION s , ,_ ,k.= 0. n- , r.2 Q,:?_ : CUSTOMER TO PROVIDE <br /> OWNER AME! <br /> Ct\ V�(vv".' <br /> Li Zoning Status;CUP• <br /> OWNER ADDRESS (Number,Street,City,State,Zip) g ' <br /> Deed Restriction;CSM <br /> 6-6) a Co S c ?- ,.\_ I _(-c,•t\ \ki 3�3LI Variance(# ) <br /> H <br /> ME PHONE CELL PHONE E-MAIL ADDRESS <br /> °) -5') c^v.,c_ - a v-\,n Wortc f 0._)C\\cx-c c ,r ❑ Site Plan drawn to scale <br /> AGENT INFORMATION - CONTRACTOR INFORMATION.: ' 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://accessdane.co.dane.wi.usa! ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rtY <br /> ❑ P A R C E L U 5/ ?1 q 5a 1�./ (Z.- ) 3,t19 o,c, frontage drawn to scale. <br /> TO NSHIP: SECTION: <br /> ❑ Driveway permits <br /> 0b'•�r ��: ����' (state,county,town) <br /> ADDRESS: ( ty,town <br /> 4'O(-) �U CC r ' ')\( °r• \'� s'35 39 CI Sanitary permits <br /> CSM: LOT S BDIVISION BLOCK/LOT <br /> ?-7 (public,private) <br /> PROPOSED PROJECT INFORMATION; F . Aa *;#- <br /> PROJECT DESCRIPTION ;-, ., i <br /> eh <br /> Par\C:cn i- u�\ oC' ck■sS s\cu, c <br /> i e- , a <br /> ❑This project is a new building or structure. 4LS. qlh ,- <br /> ®This project is an addition/alteration to an existing building or structure. rte = , k <br /> sue <br /> � s° f 7 `- 1 SANITARY SERVICE: PERMIT NUMBER: - , .: <br /> ❑SEWER ❑SEPTIC <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached gara•es and above grade decks or porches) ,j" V_ g <br /> BASEMENT: 1ST FLOOR: <br /> C'T '1-7 Q .4, TOTAL SQUARE FOOTAGE: ,1, v -Et 4 <br /> 2ND FLOOR: 3RD FLOOR: d (� • S S : <br /> ESTIMATED CONSTRUCTION COST: ,® ^g�g,i2 <br /> (Please round to nearest dollar) '♦ '♦ --► "♦ ♦ '♦ 1, 1 000 �' .,. , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No 12 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? CI 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 J2No <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 /> APPLICA MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on TION Back) —► —► —► <br />