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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION =- ?', ';;;.,ao . ; .,._. '.1 :`•' . CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> (7472/ 7`-r-% L7 _JO///75v4/ ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> /2- 3 i7� '//1-( /A. L:/)6527Z A/, / Variance(# ) <br /> HOME PHONE rr CELL PHONE E-MAIL ADDRESS <br /> L oz---S ❑ Site Plan drawn to scale <br /> AGENT INFORMATION - CONTRACTOR INFORMATION'' and includes dimensions <br /> AGENTSIAME CO TRACTOR NAME <br /> �.-4 7., —..lw. ��.%t!i7-217 0e 6/?/y/57ZZ� ❑ Site Plan including location <br /> A ENT ADORE S / CONTRACTOR ADDRESS >`,, of well/septic <br /> ZeV 5Cr//V J/o' 2 O _ _'r/2�/G/)7/- AL • <br /> 74,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 5 2 - c/!7VA/, `"_5 3sr 92z)/,G,A-77z)A/, s Y <br /> PHONE PHONE ❑ Site Plan approval from <br /> oe/- E73 - F77 sot- 2-W- ,97C-/ applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /7 L / 'v, c—c ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION::(http:1/accessdane.co.dane.wi.usn ❑ Elevation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rtY <br /> ❑ PARCEL t /2-_2/2.5.0 /1 � v 5f Z7 frontage drawn to scale. <br /> NUMBER /T <br /> TOWNSHIP: . SECTION: <br /> thESS ❑ Driveway permits <br /> / /<: �( �/ /</.: N K1 ( county,town <br /> /, / state,coun ) <br /> /273 lT/ //�/ A "�22 &E70,-(/ , W1 ❑ Sanitary permits <br /> CSM: LOT 1 SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION;!:`;� TA <br /> PROJECT DESCRIPTION: 4 N.5- <br /> a <br /> �/6 /6 i-( - <a a '.,./_o :vi 1 it " a 0 <br /> ❑This project is a new building or structure. &r_ saw, <br /> V)This project is an addition/alteration to an existing building or structure. Y `'- <br /> SANITARY SERVICE: PERMIT NUMBER: �a <br /> ❑SEWER ASEPTIC , ��� : r� <br /> HEIGHT IN FEET: V NUMBER OF STORIES: (Not including basement) I.,, <br /> AREA TO NEAREST SQUARE FOOT: s, -- ? <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` "„ g- <br /> (d.� V <br /> BASEMENT: 1ST FLOOR: spa e e a r a <br /> N/A Z� ■, ,l, TOTAL SQUARE FOOTAGE: , ri xz� V k <br /> 2ND FLOOR:f� 3RD FLOOR: <br /> 2- --6 � I <br /> ESTIMATED CONSTRUCTION COST: <br /> e® 9� <br /> (Please round to nearest dollar) ♦ '♦ '♦ "'♦ "i ♦ $.2• ',. D.. '—� , , � w, r, � c1 J M <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 gNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? AnYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes WtiNo <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 ,I No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes B.No <br /> I APPLICATION MUST BE SIGNED <br /> 545-112(4/08) C C (Continue on Back) -► -► -i <br /> 6 <br />