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7 <br /> ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web•App# <br /> PROPERTY.OWNER;:INFORMATION 1s .. Y= ,�: ;4- 6K ,: .,,_: I <. t.� CUSTOMER TO PROVIDE <br /> OWNER q <br /> 1W/Q <br /> 1 /Ic <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS Number,S,t✓re`e—t,,iity,Stat Zip) Deed Restriction;CSM <br /> HOME PHONE CELL i so E-M4 ADDRESS � �3SS� Variance(# ) <br /> j, —g i'-W • ❑ Site Plan drawn to scale <br /> AGENT INFORMATION -: ;% CONTRACTOR INFORMATION ,_ and includes dimensions <br /> AGENT NAME j _ // CONTRA TOR NAM <br /> rt)() Uortarv�!/brl d-cy .o�1 ❑ Site Plan including location <br /> AG TADDR S CONTRACTOR ADDRESS Y of <br /> well/septic tic <br /> l x 9 '7 <br /> ( ity State, ip) R61 i ,k <br /> (City,State, •p) <br /> ❑ Setbacks <br /> PH NE PHONE ❑ Site Plan approval from <br /> CC} — 8 -957 C 8-la-9-5-7 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION '::(http://accessdane.co dane.wi.usn: ' ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER CAIb--ZRZ-5LOB-7 A- if�C <br /> TOWNSHIP: SECT N: <br /> )'. sor- 1/: S 1%1/. , /� ❑ Driveway permits <br /> ADDRESS: <br /> r� 1 L , C /V (state,county,town) <br /> 6 / fi ) g.,K' v4- - vJJ � ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION, -'� <br /> PROJECT DESCRIPTION: i r � _ ,: � ¢ �,-„ <br /> �yX ( e , l ,A : ' <br /> ❑This project is a new building or structure. _F r -,- <br /> ❑This project is an addition/alteration to an existing building or structure. ,• �' <br /> SANITARY , + PERMIT NUMBER: . � �. o)p ` ' q- <br /> ■ <br /> �� �;� 1 EPT)C _A <br /> . 4 ` a <br /> te <br /> HEIGHT I� V NUMBER OF STORIES: (Not including basement) - ` ', � <br /> � <br /> AREA TO NEAREST SQUARE FOOT: ; :¢ �� < <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> - � � <br /> I <br /> - ®� Ww� �B46EMEAA f��'�` 1ST FLOOR: 1 - -,j TOTAL SQUARE FOOTAGE: ,, i s ,. 41X,- -, <br /> 2ND FLOOR:1..X.(1 3RD FLOOR: rid <br /> ESTIMATED CONSTRUCTION COSTA : = <br /> (Please round to nearest dollar) "'o- '4- "∎ -÷ -► ' sot, <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 8!No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,'es ❑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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 4 N <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -0- <br />