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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER;INFORMATION` .,; zz- ' _'A 4'44,W .r,_r. �., <br /> = CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> gAy VA OWNERADDfIESS (NumbeSCity,State,Zip) ❑ Zoning Status;CUP; <br /> Deed Restriction;CSM <br /> 8 i« r ,lr-r -no (/-.tflor►a , L✓'i. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDFRESS <br /> d :• = • `f, ❑ Site Plan drawn to scale <br /> AGENT INFORMATION.;- - ;_ CONTRACTOR;;INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTMR NAME _� <br /> g.a /1.1401,44•11 Ci9 rye./ ❑ Sloe Plan including location <br /> AGENT ADDRESS Q p Lc.. CONTRACTOR ADDReSS of well/septic <br /> 9 a-$ ►'tr,A ph_ lb-ea-,. S,9-vfl ( — <br /> (City,State,Zip) (City,State,Zip) LI Setbacks <br /> MT l4 9'Lae 6 If4A c er?1 <br /> PHONE PHONE n app m <br /> 6,0 a - q,p )- 5 all S4 el applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION;:(http:1/accessdane.co dane.wLus1) <br /> PARENT PARCEL NUMBER: CURRENT Z•NING: ACREAGE: 1-1 Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> '/: '/'/: LivQwav nPrnlitS_ <br /> ADDRESS: <br /> (sta <br /> 81/44 t'14 WWA. i' ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION �y b <br /> PROJECT DESCRIPTION: ''A W '- <br /> �/ t I� _ -! � <br /> f � r �®n s <br /> LI This project is a new building or structure. z-;� y <br /> • MThis project is an addition/alteration to an existing building or structure. F _` s <br /> SANITARY SERVICE: PERMIT NUMBER: f1 e oil" n <br /> ❑SEWER ❑SEPTIC •• 1+i - <br /> HEIGHT IN FEET �� NUMBER OF STORIES: (Not including basement) . .- -,- <br /> .-4- ,7 3 : o u4 �t�I .` <br /> V of' "` <br /> AREA TO NEAREST SQUARE FOOT: , rf . <br /> (Outside dimen sions including unfinished area,attached garages and above grade decks or porches) ' y �- - <br /> BASEMENT: 1ST FLOOR: e / 1$ s FA• R` r, <br /> TOTAL SQUARE FOOTAGE: �� • � <br /> .--� <br /> 2ND)OOR: 0 3RD FLOOR: • '» <br /> 3.: YF s ?A *4 <br /> ESTIMATED CONSTRUCTION COST <br /> Please round to nearest dollar m .s p t, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes [ No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property'? LI Yes l No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ..., arYes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑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) DYes , g'No ❑Don't know <br /> 7. Is this to correct a violation? Li Yes RiNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -► -► <br />