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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY.OWNER;.INFORMATION, _ - ' .,. 4w_00 r , ..r:,_: < ;,. CU` OMER TO PROVIDE <br /> OWNER NAM <br /> Jc n n! "'"L L Rid,- , ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) } <br /> fiO tuo Lz k . i ,�(. �)�, 7isr.) iv 3 3>z/ Deed Restriction;CSM <br /> HOME PHONE EL ONE E-MAIL ADDRESS ( ) <br /> 66 d..-„�- ).-() c`y 3L e d-S )7-1e 1/4 ,�„i-eJ' u)C%�k,�,-)r _Plan drawn to scale <br /> AGENT INFORMATION._: , „ CONTRACTOR.INFORMATION.:T .' -‘,1;::-.;;;;-: .•• includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> • Si -. ' .n including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS e6fit <br /> I <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks /)--11 J be, <br /> PHONE PHONE • P •ii- Plan approval from <br /> (cable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION'INFORMATION '.;(http:l/accessdane.co.danewi.usl) �levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZOf'ING: ACREAGE: P P �Y <br /> ❑ PARCEL Q u_3 e. Zn/ frontage drawn to scale. <br /> NUMBER �»_ DC'a' p d�tL�.! r ` <br /> TOWNSF�IB-. SECTION: <br /> CLG';7 C T /C r��h g '/: /i h/ 1/1/: /1�F riveway permits <br /> ADDRESS: , (state,county,town) <br /> /(�' i,:Jc (t4Jc YYV?/7( - /L/ i/s v)` 12', S 3-�/ <br /> CSM: LOT SUBDIVISION BLOCK/LOT unitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION . . <br /> '� � 4 E PROJECTDESCRIPTI ,'ei?eG{-,/7 Pc)1r( <br /> ❑This project is a new building or structure. rt -� �r� .r <br /> Iv This project is an addition/alteration to an existing building or structure. I,= '- <br /> SANITARY SERVICE: PERMIT NUMBER: T f ° <br /> ❑SEWER 1, -TIC '`li st �, <br /> HEIGHT IN FEET: NUMBER OF ST RIES: (Not including basement) Vi.?... €,, . . .,s 1 <br /> mo t`=eqf tt;i 3 f"'a-V <br /> AREA TO NEAREST SQUARE FOOT: � � - <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) = <br /> BASEMENT: 1ST FLOOR: s �9a4 <br /> L' 4, TOTAL SQUARE FOOTAGE: 4, �k r: . A <br /> ft., CS / biz= " a v z ) - <br /> 2ND FLOOR: 3RD FLOOR: r <br /> ESTIMATED CONSTRUCTION COST: r7 q * m °� ,tq � <br /> (Please round to nearest dollar) "� / C LI 1_ f. . x,-f1_ ;fq u, ;; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? PrYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? RYes ❑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 1.StNo <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) W Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> iv 3? n o.o7.f- ye <br /> co APPLICATION MUST BE SIGNED <br /> q g eQ (Continue on Back) —► —► —0. <br /> 545-112(4/08) <br />