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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION :, Y= _' ''. 3..�A Vi. .',, s. :< `1;?_= :.'�� CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> R,, fr( ©4S0,, <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 7, 2.. 7.4 f cot L,✓ Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> -7s— -Std TZ._ie 7icli-LeAmu,r4,v0 414 -e-/-torn ❑ Site Plan drawn to scale <br /> AGENT INFORMATION.T.: CONTRACTOR;INFORMATION , . .y- 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:llaccessdane.co.daneavi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> © nPARCEL DS//-.z /—it 3 os-a Z) 27 frontage drawn to scale. <br /> TOWNSHIP: �/RK (i1dcNt 5f �� ❑ Driveway permits <br /> 11\\-�� 1�`: 1�1A: 1 (state,county,town) <br /> ADDRESS: <br /> 0 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> /2.YS//' 2 <br /> PROPOSED PROJECT INFORMATION, ? TA '- -4:4 <br /> PROJECT DESCRIPTION: , r : <br /> Ye x /o /y 'tP f 4 ZeA- eve-p � v <br /> 'This project is a new building or structure. i .k,, . , ' <br /> ❑This project is an addition/alteration to an existing building or structure. f - <br /> SANITARY SERVICE: PERMIT NUMBER: m ' �°i. �- -z}h <br /> L siwva V <br /> ❑SEWER ❑SEPTIC � <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) r ,- <br /> P AREA TO NEAREST SQUARE FOOT: g �V�sl %-' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 2, <br /> BASEMENT: 1ST FLOOR: FF �" FI <br /> 4, TOTAL SQUARE FOOTAGE: 4, ° . ,. ± <br /> 2ND FLOOR: 3RD FLOOR: �E <br /> /Goo , : ; <br /> 4 � ;7- <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► ♦ ♦ �� e1 .aP kt g `� <br /> (Please round to nearest dollar) 00 - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ayes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑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? es ❑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) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? es ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />