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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT_to Web-App# <br /> PROPERTY OWNER iINFORMATION`„i., .• =_x-, � was %-. �,-..- r, .:1 <br /> CUSTOMER 0 PROVIDE <br /> OWNER 1T <br /> ` -e U\NAME(�'` �, <br /> \e- ` W).3. ❑ Z Wing St.tus;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> eed 3'100 K) , rr `�c' �'.t VA a ('-�j�td , l,l)i 63s 3\ aria R: (triction;CSM ) <br /> aria c: # <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (005- , -g`10") (008 .. e - , e"`1 SO04 31 tut a-■OD C4 -A \ Side Plan drawn to scale <br /> AGENT INFORMATION - CONTRACTOR INFORMATION = aid includes dimensions <br /> AGENT NAME CONTRACTOR NAME ' <br /> DJSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS fof well/septic <br /> ,State,Zip) (� r <br /> (City, p) v �- (City,State,Zip) Setbacks <br /> PHONE PHONE . ❑ Site Plan approval from <br /> applicade tctwhship: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ FlOOPI5fallS to scale <br /> PROPERTY/LOCATION;INFORMATION.(http:l/accessdanecn_•±ane.wi.usl) : [ /Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: A -EAGE: , <br /> ❑ PARCEL ''11 '7 4T` 6 '44 frontage drawn to scale. <br /> NUMBER O�ld-�3`t-�,�t0- � �"\� � J . � g <br /> TOWNSHIP: SECTION: <br /> .11-e-e:c-Ve\ a i4: <br /> 1/1/4: ❑ Drivewaypermits <br /> ADDRESS: (stare,COUn ..,/own) <br /> ?1101 !. FCtac Oak ?("l ❑ Sanit. 'permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> I O$Co 0 a (p7 • ic,private) <br /> PROPOSED PROJECT INFORMATION,.' 71.E <br /> PROJECT DESCRIPTION: f . <br /> k t CoC 'v c, Of . . s\-�e\ Vi o S � ` <br /> El This project is a new building or structure. -i'u- .. ' . ,, <br /> ❑This project is an addition/ Iteration to an existing building or structure. - 1.--2, z <br /> SANITARY SERVICE: ®! 4--1-11,27--=‘--ti1 �- a- 5 gas' <br /> PERMIT NUMBER: _�� �� <br /> ❑SEWER PTIC ' �� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT a ;< - , , ' ate <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ..' 4 <br /> ®R ® P BASEMENT: 1ST FLOOR: Q::)`"7� ad g 4, TOTAL SQUARE FOOTAGE: <br /> l d <br /> 2ND FLOOR: 3RD FLOOR: CO 7C7I ,1 X51..-�J �-` k w ` t <br /> ESTIMATED CONSTRUCTION COST: ._ %' �, � �y <br /> Please round to nearest dollar� _ <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 ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? IA Yes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? I l 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 NI No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes I No <br /> I q) APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />