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ZONING PERMIT APPLICATION www.countyofdane.com 5UPPLEMENT_to Web-App# <br /> PROPERTY OWNER.INFORMATION j,,:;:: , __ ,?. ,. ' a,1,-, ._ .,,,_ <,;-,1;�i <br /> CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> '� o0(Q ❑ Zoning Status;CUP; <br /> OWNER ADDRESS ( mber,Street,City,State,Zip)_ r 1 Deed Restriction;CSM <br /> C.Q.c 12�j 1\ _ ke_co S� -Qo6 a h)(52C) \ALL (5j( 535-6 0 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> - 1 X)I rnel V'�1c/ etn1-c!r13k ` . ❑ Site Plan drawn to scale <br /> AGENT INFORMATION - ,;- CONTRACTOR INFORMATION ? ,--i 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.us1) , <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL }I Hg CC V,V\ 1 1 4 frontage drawn to scale. <br /> NUMBER 0�3)-1'�$C�`(c o4I-g�l� <br /> TOWNSHIP: SECTION: ❑ Driveway 4-7-61 & 1.t`e_ o 1/4: 1/4%: 0"E ypermits <br /> (state,county,town) <br /> ADDRESS: <br /> (0 t 2C Mi✓'6Atu cc- R6 1N1c �v L-3I S 350° <br /> ❑ Sanitary permits <br /> CSM: . LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 4 "ug - <br /> — <br /> PROPOSED PROJECT INFORMATION, ;: i ; � - '""°"-'"`; <br /> PROJECT DESCRIPTION: t� TA -V <br /> Er-This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. _ r4> <br /> w ;,; .t <br /> SANITARY SERVICE: �� PERMIT NUMBER: � ' ;p <br /> ❑SEWER U SEPTIC " �` ,' " <br /> .: <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ��.,,_ `���� , " �„� <br /> 18 �- i r e' <br /> 0 -to <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ,, <br /> BASEMENT: 1ST FLOOR: <br /> , TOTAL SQUARE FOOTAGE: ,1,/Q e 44 <br /> 2ND FLOOR:{( /} 3RD FLOOR: <br /> 1'\ £2 r i .� 3 -,` '''"r"ate" <br /> i +0X, 7 44- <br /> ESTIMATED CONSTRUCTION COST: <br /> ♦ '-0 --► --i► -► -► rj- tiAl-Va6:0Pcal-)K.Aii, '(Please round to nearest dollar) / (�(�JQ „ u x , :, ` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes al-NO ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Flo Li Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? , ®'s Li No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes a ilo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le) blank if none) <br /> 6. Is a location survey required? (see reverse) 1 Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? LI Yes ❑ <br /> 102 ,0° APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► —O <br /> 545-112(4/08) <br />