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ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web-App# <br /> PROPERTY OWNER:INFORMATION' �;;? _ i?4*P' 40: • -.,; z, {:_ CUSTOMER TO PROVIDE <br /> OWNER NAME re rr_ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) L ❑ Zoning Status;CUP; <br /> 7.2 �O �Gy/P�r'" 7� D�'� �h41 �/ 5354; Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> gal .?7 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION._::, �',? CONTRACTOR INFORMATION ,'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://accessdane.co.dane.wi.us)) , <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL �ca, t R—/ 1 . 7 frontage drawn to scale. <br /> NUMBER �'' b5' 14.14 6 /3 p O 1 <br /> TOWNSHIP: SECTION: <br /> S f {-pc I n 1 6 Y: S E. 1/%: s-',J ❑ Driveway permits <br /> ADOR�ss: ' I (state,county,town) <br /> 7 4o C. 0,/-t r N'I" 0r ❑ Sanitary permits <br /> CSM: LOT <br /> SUBDIVIS BLOCK/LOT <br /> (public,private)I n)°%O <br /> PROPOSED PROJECT INFORMATION, ';; ' <br /> PROJECT DESCRIPTION: /� �� €Ir ( _ . <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: 4 � 4 r a <br /> PERMIT MBER: --,,--; , ,i-'n <br /> ❑SEWER SEPTIC tJ J Ji, i '-,O <br /> HEIGHT IN FEET g I Q q NUMBER OF STORIES: (Not including basement) <br /> R! G7 '�i; ,'a r i{ '`� <br /> _ F rZ <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) x y0. 44 ,2,`g' �: <br /> BASEMENT: 1ST FLOOR: 0 V•' V - <br /> 15o ,, TOTAL SQUARE FOOTAGE: 4, a <br /> 2ND FLOOR: 3RD FLOOR: �� <br /> a <br /> ESTIMATED CONSTRUCTION COST: <br /> ® g I p(Please round to nearest dollar) -0. -0. -0. -0. "i ♦ ' Q O 00 f , <br /> 1. The property is within 300 feet of a stream or 1000 feet,from a pond or lake? ❑Yes ANo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes IN No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes al No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 14Yes ❑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 1'No ❑Don't know <br /> 7. Is this to correct a violation? JaYes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► - - <br /> 545-112(4/08) ) -0. -0. <br />