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. .) / c..... <br /> - ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY.OWNER`.:INFORMATION : __ ' ' r; 11-:<'.;: x,._>` ;i.;'`: CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> i I Fc f_- A Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Str t,City,State, ip) Deed Restriction;CSM <br /> 600 0-e poV F Si- Variance(# ) <br /> HOME PHONE i CELL PHONE E-MAIL All.RESS <br /> • -'Z a)"o Q . ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR'INFORMATION:.; . and includes dimensions <br /> AGENT NAME CONTRACTOR NAME , <br /> ►I it Plincluding location <br /> AGENT ADDRESS CONTRACT.- .DDRESS of�l�""c tic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHON PHO, tliti 'it Plan a royal from <br /> applic ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ib • Floor to scale <br /> PROPERTY/LOCATION INFORMATION '.(http://accessdane.co.dane.wims/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: - Elevation of property <br /> ❑ PPi MBER aq i 9 °ld"' B Cs Q /Q.- 3 frontage drawn to scale. <br /> TOWNSHIP: SE TION: ( c 1,-\/ �� rive ermits <br /> ADDRESS: <br /> So u� 1�4: / ' 1 t�1�4:S ( ty, ) <br /> stat ,c n town <br /> ( oG Pepe SF <br /> San •ermits <br /> CSM: LOT SUBDIVISION BLOCK/01T �p , ; •rivate) <br /> PROPOSED PROJECT INFORMATION , <br /> PROJECT DESCRIPTION: n(� / ; : A . . h - k' <br /> U t-C h ' o- t o t x n T°e"7 <br /> • ❑This project is a new building or structure. w <br /> , his project is an addition/alteration to an existing building or structure. r _` ,1 <br /> SANITARY SERVICE: PERMIT NUMBER: q- % e`rF '� <br /> EWER ❑SEPTIC ��" �' �� i ` ,� <br /> .: - '1 <br /> HEIGHT IN F • NUMBER OF,STORIES: (Not including basement) /T`- r{ <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �BASEMENT: t,1STFLOOR:- r ` � <br /> I 0 ,, TOTAL SC1Wr '1 : 1 'ir` dk,' i. r ,,. <br /> 5 �, - <br /> 2ND FLOOR: 3RD FLOOR: I ^ <br /> 'ESTIMATE£D CONSTRUCTION QAST . . .. s r* B <br /> (Please round to nearest dollar) r "� '� ��� r- 4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes )214■10 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lit No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes �CNo <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 -12.No LI Don't know <br /> 7. Is this to correct a violation? , Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —I. —0 <br /> 545-112(4/08) <br />