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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#. <br /> PROPERTY OWNER INFORMATION .. _; , '<'I. !`, _44.\, ,;: .i; r,;.1 a CUSTOMER TO PROVIDE <br /> OWNER NAME 9 <br /> J et 11 1 I-r e e ja, betty ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,Citr,'State,Zip) Deed Restriction;CSM <br /> 140 6'b 6-fei, RBI Ike rd'es 4-- , "1I C3 5 3,,), Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 71 - 5 8 6 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR;INFORMATION`:?r 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:1/accessdane.co dane.wi.usn; ❑ Elevation o <br /> Elevatiof property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P y <br /> ❑ NUMBER • 7 0 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> tAi /1 S 0 r I ,/. 1/4%. ❑ Driveway permits <br /> (state,coun ty,town) <br /> n <br /> )ADDRESS: <br /> 140 6 6 C f cl / R o <br /> ❑ Sanitary permits <br /> CSM: LO SUBDIVISION BLOCK/LOT (public,private) <br /> 36 s7 1 Ivv <br /> PROPOSED PROJECT INFORMATION. i:11*.4'i TAB <br /> , <br /> °. <br /> PROJECT DESCRIPTION: J� b <br /> i <br /> This project is a new building or structure. W-• �F <br /> i'I is project is an addition/alteration to an existing building or structure. L M <br /> SANITARY SERVICE: PERMIT NUMBER: flit <br /> x <br /> ❑SEWER I SEPTIC '"'' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) { � <br /> AREA TO NEAREST SQUARE FOOT: a1. r <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , ' j <br /> i BASEMENT: - 1ST FLOOR: 7 a - a 1F�2 � J <br /> /I 6 I TOTAL SQUARE FOOTAGE: 4, � . 4 tat <br /> 2ND FLOOR: 3RD FLOOR: F <br /> ESTIMATED CONSTRUCTION COST: e��, <br /> (Please round to nearest dollar) "� '� 4' ' , r " , = <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 1:EiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes CZ No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? aYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI 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) ❑Yes , I No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes in No <br /> #116 -f. 0o1S - 3� <br /> So v APPLICATION MUST BE SIGNED <br /> C (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />