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ZONING PERMIT APPLICATION www.countyofdane.com .SUPPLEMENT to Web-App# <br /> PROPERTY.,OWNER.INFORMATION ‘:7,.::;.;:.:::,z-,- ;,.. ;,I' '.: w; 3 Th -1. .- s∎Pi; g; CUSTOMER TO PROVIDE <br /> OWNE <br /> RO v'_r � r / S ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Stare,Zip) g 'CUP; <br /> I Deed Restriction;CSM <br /> SR o,-t- c.acj 37S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> •64 '1. 573 5 •6Y 35-4 4'-24 3 60...b/a ti.esvil//50.,)//0-/"'q'(• 0"1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION. :: CONTRACTOR INFORMATION`?.= .;' ,, 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://accessdane.co dane.wi.usn ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: " ACREAGE: p P y <br /> ❑ <br /> NUMBER , A (�(1, ,o e„._-.0.s- <br /> TOWNSHIP: frontage drawn to scale. <br /> SECTION: <br /> s ❑ Driveway permits S. -F t f L i- % //: <br /> ADDRESS: (state,county,town) <br /> i5& •Hu ( .13t3 <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION: - f ;,i g <br /> PROJECT DESCRIPTION: t�',� z* <br /> F V .. <br /> 61(31-(Z 0/1 t�'l)lt%`a)L'uL' C.EtE�fe iCvLiTJ/cs�!_1 [4-4k.z.=:'".�� ,�.--�x l,`" `� � <br /> F/ � <br /> ❑This project is a new building or structure. i `` 1. e 3_,1:_g v ' �` <br /> ❑This project is an addition/alteration to an existing building or structure. z m, ,k - -' <br /> SANITARY SERVICE: ,y( PERMIT NUMBER: e e a9!' , " �` <br /> ❑SEWER U SEPTIC i i a a v 'il y .: <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) .} ` ' c <br /> AREA TO NEAREST SQUARE FOOT: *; <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , , <br /> BASEMENT: 1ST FLOOR: a e ®��`t� . �� <br /> �, TOTAL SQUARE FOOTAGE: 1 �(- i 4.� <br /> 2ND FLOOR: 3RD FLOOR: �'1 `su a7 4 j_ 'T',-;17;. --: <br /> ��TT'��� per- s, <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -4. TLi® 1�,-,..t,--A <br /> ap <br /> (Please round to nearest dollar) $ .Z',c ' r , .z,,. , <br /> c`x70 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes 6 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? CaYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? d 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 allo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />