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ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web•App# <br /> w <br /> PROPERTY.OWNER;:INFORMATION �;,: w= ' �� � ; �,J;, CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 4.4771a ye so A/ T/2 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> GZ1'76- GL.E,VA/ .j2 S7 h'r'oAJ Lt./S; 3.5 8 7 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 649 3 23 02.02 ❑ 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 CONTRACT.- DDRESS of well/septic <br /> acme <br /> (City,State,Zip) (City,State,Zip) LI Setbacks <br /> PHONE PHONE • ❑ Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESB7 <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co dane.wi.us1) "' <br /> PARENT PARCEL NUMBER: D ar CURRENT ZONING: �/ ACREAGE: ❑ Elevation of property <br /> NUMBER 0 6/I"oZ1�—G6S -7 A -2 ( E .6o ECR f f rn frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /13Z EA 5.41 —7— SPR-r/va5 0; '/: WA: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> • <br /> 02359 G O u/v7y 4" -'o h' W4Y ," STDU //PA (4 535 i ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 0 ,236 <br /> PROPOSED PROJECT INFORMATION, <br /> :,‘,.N.:1."1 <br /> , �r ���� <br /> PROJECT DESCRIPTION: ,,11 <br /> I`i <br /> ❑This project is a new building or structure. �� <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: i ° 4 <br /> F aF—_a, #trta age, E _ <br /> ❑SEWER ❑SEPTIC ,..: <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) <br /> 13 fl A/ <br /> oN� �l,,r rF,a <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) orr, <br /> � � _ r Pik 1ry�e� l J r F4t' <br /> BASEMENT: 1ST FLOOR: <br /> ad-IX 7 O , TOTAL SQUARE FOOTAGE: f �����F + a�F f rr <br /> OHO );t � 9s;�� <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: r��� <br /> (Please round to nearest dollar) 620° • 00 <br /> 4 ct(o <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I 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? ❑Yes ®No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 23 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 0 No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► —► —► <br />