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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION` -, CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> / ve - Li 4 (�k?3v\_0) <br /> LI Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) V.O _ B6`F- 6Z- Deed Restriction;CSM <br /> oce.c,i"VLIa) Wt ?.7j`1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> tOf,7.1-(SS—O' (9 /l ei 6)5004e5"e✓'Jtce- •r-e`� I; Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO TRACTS• -ME <br /> *, ',. g' i- 't° 4'�a...4.ee,r'e ' , lSite Plan including location <br /> AGENT ADDRESS CONY' TOR ADD S of well/septic <br /> ,0,0 , . of - <br /> (City,State,Zip) (city,State,Zi. v✓i- Setbacks <br /> —/L ' i-3O5' <br /> PHONE PHONE ❑ Site Plan approval from <br /> r r a0. - — vt 3 66 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS St C , <br /> - • 14-l. -1 /, <br /> , y loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: C)51 p p rty <br /> ❑ R 7 acres frontage drawn to scale. <br /> NUMBER CEL �7! �—3/y-�00 3- 3 � <br /> TOWNSHIP: nn ,, SECTION: <br /> Oeen PQcL 3 / '/.: A/ %1/4: S E 11 Driveway permits <br /> ADDRESS: (State,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT I Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION F •- - <br /> PROJECT DESCRIPTION: <br /> i _ <br /> ,S1 This project is a new building or structure. @i7a <br /> This project is an addition/alteration to an existing building or structure. t,, X <br /> SANITARY SERVICE: PERMfT NUMBER: * i 1i L ? " - - <br /> ❑SEWER aSEPTIC S r D- 1 y, ` ,r F,' `9 <br /> HE IN FEET: NUMBER•F STORIES: (Not including basement) €L' <br /> AREA TO NEAREST SQUARE FOOT: u s <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , -- '°' S <br /> BASEMENT: 1 T FLOOR: ''''''''',71 <br /> FO 4 V ,�, TOTAL SQUARE FOOTAGE: 4 , °s . i E �- t <br /> 2ND FLOOR: • 3RD FLOOR: -it ri tt�, <br /> �, � <br /> STIMATED CONSTRUCTION COST: ♦ ♦ ► ♦ ♦ ♦ Q� r �� r� :� r .- . 1 <br /> (Please round to nearest dollar) $ t... �.� r__ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes la No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,®No LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 4Yes ❑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) DYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ,Q No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —► <br />