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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web•App# <br /> PROPERTY.OWNER;.INFORMATION r _ �.� � z� r.i . CUSTOMER TO PROVIDE <br /> OWNER NAME { y� <br /> T Q IY\c,l 4 e4cg. wS <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 13I Iakc ; Variance(# <br /> HOME PHONE CELL P ONE E-MAIL ADDRESS <br /> 6r ', Z 1 6. T 6," 1\414-4-3S cr ❑ Site Plan drawn to scale <br /> AGENT INFORMATION _::;< CONTRACTOR INFORMATION , , and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> .S c iNOC S 4 ❑ 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://accessdane.co.daneavi.usa <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER 001-1 c7.S tj 3/4, o% 3 60 g I �a S% Ft <br /> TOWNSHIP: SECTION: <br /> b.'. 3 ,/: <br /> 1/4.1/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 13 I d ct IL, U 1 c w V L ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION B OGK/LOT <br /> 11 of i 2. of 1 k 2 (public,private) <br /> I Z �� `. hWoOU ln. e. <br /> PROPOSED PROJECT INFORMATION. ' <br /> PROJECT DESCRIPTION: <br /> mss: <br /> ❑This project is a new building or structure. <br /> ?' fi lm' � F <br /> 52 This project is an addition/alteration to an existing building or structure. r <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> NI SEWER ❑SEPTIC �� <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) � � <br /> -z 11+ EE <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) �-, <br /> BASEMENT: - 1ST FLOOR: <br /> s � e <br /> %O S tt, I D O s tt F•+ 4 TOTAL SQUARE FOOTAGE: 4 l k - �t,.��d t4.-1 ° ``t' <br /> 3 �° $ <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: / o O ry � - <br /> (Please round to nearest dollar) $ � d a <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? CI Yes ®No LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? MYes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes RI 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 ' No <br /> X © 071-= 62( <br /> _C67 APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -0 <br /> 545-112(4/08) <br /> / j�. o <br />