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• <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY.OWNER:INFORMATION ;i _ '' u' I,3 {_{ <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> OWNER ADDRESS (Number,Street,City,State,Zip) `� NO Zoning Status;CUP; <br /> ✓ V <br /> 7/L /0(,,/mot- OLJ , /� Deed Restriction;CSM <br /> bjQ• " PHONE • CELL PHONE E-MAIL ADDRESS y Variance(# ) <br /> 1 - 4/41 /7 0S-", .. Site Plan drawn to scale <br /> AGENT INFORMATION_-:: CONTRACTOR INFORMATION ' - <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAA,E / <br /> AGENT ADDRESS 11,E 4-T c� GVLtfioP Site Plan including location <br /> CONTRACTOR ADDRES�S of well/septic <br /> � <br /> (City,State,Zip) (City, ip) _ Setbacks <br /> PHONE <br /> PHONE C � 2, �l 3�� <br /> Site Plan approval from <br /> b S — W3 .3 O38 applicable township: <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS <br /> cI r.e__"iC7V0.TrCos,Oki//4/,L,-tc,;4� El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION ':(http:l/accessdane:co danewi.us/) <br /> PARENT PARCEL NUMBER: CURRENT NING: ACREAGE: Elevation of property <br /> PARCEL O io 093- i/ZZ - 7 <br /> NUMBER /}G 3 87`--/0 N./01-- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Thd`Y^'n 5W '/: 9 V//; 6it 7 Driveway permits <br /> ADDRESS: (� ((�� (state,county,town) <br /> g 7/L LOT o"./Lr (200, - ot.Jl f?P hk,,n, h, (n�! <br /> CSM: SUBDIVISION BLOCK/LOT '� Sanitary permits <br /> 12 .,.��,,j- 13 ?Art •rivate) <br /> G'rc�nr��•� tea 5 i /2_1 i3 <br /> PROPOSED PROJECT INFORMATION; <br /> PR T SCRIPTION: � 3 A <br /> ❑This project is a new building or structure. 'Y <br /> �� '4_P :' <br /> This project is an addition/alteration to an existing building or structure. ,' :' <br /> SANITARY SERVICE: PERMIT NUMBER: �tv'e n(p`Iv !;F <br /> SEWER ❑SEPTIC ' �` i , N <br /> HEIGHT IN FEET <br /> NUMBER OF STORIES: (Not including basement) - <br /> 9' / # 0),017 £1 <br /> AREA TO NEAREST SQUARE FOOT: <br /> r�� � � ` <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) "� .k -. <br /> r BASEMENT: 1ST FLOOR: <br /> e 1 t"'Ns-1 le �t1i Z 4, TOTAL SQUARE FOOTAGE: j <br /> C 0.0.� r �� w 2ND FLOOR: �" 3RD FLOOR: L/ <br /> ESTIMATED CONSTRUCTION COST: i e�, ( " 'r°( `��� <br /> (Please round to nearest dollar) -4. —► —► —► —► —► .u{n �j 9� 2= - . ..s,� <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 ❑No g i.n'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 0..No .i <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ve blank if none) <br /> 6. Is a location survey required? (see reverse) <br /> ;2(Y-. 0 N ❑Don't know <br /> 7. Is this to correct a violation? •Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —0. —► -1. <br />