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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com ...SUPPLEMENT to Web-App#: <br /> PROPERTY.OWNER INFORMATION ;'_, - , 4Yil::. - ..mss- ,;,s 1 ' <br /> �- •TOMER TO PROVIDE <br /> OWNER NAME --7- • <br /> V ' /I' ■ Zoni • Status;CUP; <br /> OWNER ADDRESS (Nym ber,Street,City,' ate,Zip) De.• Restriction;CSM <br /> 6Y 3 4' "✓ / /0// .96-7-o.14/ V_ lance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> °mil-73 7 3 11 :ite Plan drawn to scale <br /> AGENT INFORMATION , - CONTRACTOR;INFORMATION:: r and includes dimensions <br /> AGENT NAME® CONTRACTOR NAME <br /> �©OtP- 5 " /4iL/ F Sl9--,1/12 r Si Plan including location <br /> AGENT ADDRESS CONT ' CTORADDRESS o well/septic <br /> o)C 6-m7?- -fl <br /> (City,State,Zip) (City,State,Zip) • Setbacks <br /> PHONE . / PHONE • to Plan ap al from <br /> 7,00 .ppli•- ownship: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /'A g/ar f?/zs2` T' i# _ L F1'or plans to scale <br /> PROPERTY/LOCATION INFORMATION '.,(http:l/accessdane:codane.wi.usn, • levation of prope <br /> PARCEL UMBER: j/ CURRENTZ NING: ACREAGE: p pe <br /> ❑ rraBEER (�:0: ?'y ?4 -. R^i ( ( , frontage draw : scale. <br /> TOWNSHIP: SEC Oht.i <br /> 36"/C/,le 2) .°_! ,/. S F 1/,A: • Drive, - permits <br /> ADDRESS: (S - e,county,town)( • <br /> 69I-3 /�l • Sanitary permits 1-ev ,Il, <br /> CSM:02 4 W • LOT ( SUBDIVISION BLOCK/LOT (p •lic,private) i e e <br /> PROPOSED PROJECT INFORMATION <br /> 'ROJECT IESCRIPTION: ''/_ <br /> •y 7 7 /77071✓ �. <br /> g <br /> ❑This project is a new building or structure. • -' _', : <br /> i z , °ice' p.°i <br /> This project is an addition/alteration to an existing building or structure. 1 G :, * _- <br /> SANITARY SERVICE: PERMIT NUMBER: .:-k 4. ..i� ` <br /> ❑SEWER /.SEPTIC "5� <br /> HEIGHT IN FEET :: 5 :' r <br /> NUMBER OF STORIES: (Not including basement) �. 3 � : <br /> /6 ! 9r ; 3i®if 1'il c F j <br /> AREA TO NEAREST SQUARE FOOT: <br /> �` p <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) "°'t" ,' , -, `e-aS <br /> BASEMENT: 1ST FLOOR: V y g �q,e.e t- r ier4 <br /> 4, TOTAL SQUARE FOOTAGE: C_4L`...iV .1_,A <br /> 2ND FLOOR: 3RD FLOOR: �� <br /> � y� Y\ <br /> ESTIMATED CONSTRUCTION COST: <br /> r z °� ��fi '(Please round to nearest dollar) -+ "-∎ '* $ 30,9 O O f As , ,x ., <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 01 Yes ❑ ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes Lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• one) <br /> 6. Is a location survey required? (see reverse) CI Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -* -0, <br />