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• —31°) D'1S S s Q4� <br /> 'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER:.INFORMATION ,__ '.;' ,4 ?��;�, , , .=,_,< L,;._`i:-:.,,� CUSTOMER TO PROVIDE <br /> OWAME <br /> pW ell- CO 45 -sue �' Zoning Status;CUP; <br /> OWNERADDRESS (Number,Street,City,State,Zip) / fr7CidLi Deed Restriction;CSM <br /> CGS Cdt®1.e, G --au-c_ Tai �37/�j arne(#HOME PHONE C HONE E-MAIL AD ESS <br /> 1- 7 7,P© Z f /3c w eCit <br /> z7�1� Z7 orcrj h-e'l— -�' 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 /> • <br /> (City,State,Zip) (City,State,Zip) 1 Setbacks <br /> PHONE PHONE • 111• Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 9 loor plans to scale <br /> PROPERTY/LOCATION INFORMATION ':;(http:1/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURR�"}TTZONI G: ACREAGE: '� levation of property <br /> ❑ NUMBER onto �'- '4'3 , •, Jam" S fr• tage drawn to scale. <br /> TOWNSHIP: SECTION: ` Drive <br /> )\ Sc ✓' lT \ '/4: 1/1/4:5 �/ Y Permits <br /> TT" Stat, ounty,town <br /> ADDRESS: � `7 ) <br /> Sys , vJ R I 14 9 3 II►. <br /> � �� � � ' Sanita\ per 's <br /> CSM: LOT SUBDIVISION BLOCK/LOT s 4 public, •ri - e) <br /> 1 cx li∎t 61P+1 1 _ <br /> PROPOSED PROJECT INFORMATION - r <br /> PROJECT DESCRIPTION: . F., £ { s! - <br /> �../ .— . ci ' °`*^1 9.'9 ., k„_ <br /> his project is a new building or structure. 3 <br /> ❑This project is an addition/alteration to an existing building or structure. r r- £_ '-4'-iii <br /> SANITARY RVICE: PERMIT NUMBER: � $ � at- <br /> EWER ❑SEPTIC ti, *° 17 - <br /> HEIGHT IN FEET /s NUMBER OF STORIES:I(Not including basement) t <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) i il, <br /> BASEMFNT 1ST LOOR: ^_ e 4 e r <br /> 4, TOTAL SQUARE FOOTAGE: , �'� i (, .; <br /> 2ND FLOOR: 3RD FLOOR: <br /> � '; O ' I <br /> ESTIMATED CONSTRUCTION COST: <br /> Please round to nearest dollar t.a� 1 i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,...... 'No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes jlo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes o <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 LI No Cl Don't know <br /> 7. Is this to correct a violation? LI Yes .❑,No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/05) <br />