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ZONING PERMIT APPLICATION www.countyofdane.com .SUPPLEMENT to Web.App#- <br /> PROPERTY OWNER,INFORMATION j,,; .. z=_ ,' '; .I.„ a, :< `, , r CUSTOMER TO PROVIDE <br /> OWNER AME /,1 <br /> 72n't e'�� 7 ❑ Zoning Status;CUP; <br /> O ERADDRESS (Number,Street,City,State,Zip) �yJ Deed Restriction;CSM <br /> 3 & Tev/J�S � i-le L d wr 00 Variance(# ) <br /> HOME HONE CELL PHONE E-MAIL ADDRESS <br /> 1; ;Tor"". : 2-8 yd ' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR:INF.ORMATION;.;' ' 1 -. 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:1/accessdane.co.dane.wi.usn;; ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P rtY <br /> ❑ PARCEL o0 8/02/0t5��^ . 3 D_-4 frontage drawn to scale. <br /> NUMBER V� IL <br /> TOWNSHIP: S TION: <br /> g/06B/oa, v � <br /> /2,0`Al rz) .1/4: , ,/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3 3 9 ' t A /°/90e-- ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION . , BLOCK/LOT (public,private) <br /> • 17 rI e <br /> PROPOSED PROJECT INFORMATION "TA <br /> .PROJECT'ESCRIPTION: ,t s- .� <br /> This project is a new building or structure. xp i£I'`kY <br /> This project is an addition/alteration to an existing building or structure. _ = ,_ <br /> SANITARY SERVICE: PERMIT NUMBER: CT° e or`p <br /> ❑SEWER SEPTIC iik-: 1: , <br /> HEIG�HH( IN.T FEET NUMBER OF STORIES: (Not including basement) ' £7t , <br /> Np ��r�1�4AREA <br /> TO NEAREST SQUARE FOOT: : Ex - , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - �i - fig_ <br /> r <br /> BASEMENT: 1ST FLOOR: ® ® �,-" <br /> 4, TOTAL SQUARE FOOTAGE: �, , °E � °�` <br /> 0� } <br /> 2ND FLOOR: 3RD FLOOR: <br /> ?g,{116711 , F �' <br /> Mqr a der '-� -z <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) $ s—on., ®c) ,; =� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes LANo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes NNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes XNo <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 X No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> 9Q >( 0_v?S' <br /> 0 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 3 ii # l ' V. (Continue on Back) -► -► -+ <br />