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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION ,''¥4i".':,.�. r ,Z 11-''':: CUSTOMER TO PROVIDE <br /> OWNER NAME : <br /> al J ` -0 N 44U,ele,,J <br /> ❑ Zoning Status;CUP; <br /> OWNER DDRESS (Number,Street,City,State,Zip) —C • Deed Restriction;CSM , <br /> HOME PHONE-7 77 se/HA LLex'?D vFin 104 ( wis35 / variance(# ) <br /> PHONE E-MAIL Rib 66'f V( - 0/� / U, 6 D-95-7 ) /14 i O S'114 <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION , CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C� ow-7)6g I&KS LI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 'of well/septic <br /> c3-1-1 /7'1cClu eitvii <br /> (City,State,Zip) (City,State,Zip ❑ Setbacks <br /> f(eg�GL( w I 35-13 <br /> PHONE PHONE g ❑ Site Plan approval from <br /> lc j - c 7L/ — .25-1 / applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> �; -- �� -,;/%-,, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danew➢.usn ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ P RC ER BPS , c c frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> in 0h70Se-- 1/4: 1/1/: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 7g 77 Scr"G11 i- Pat Ue" rca, t%U/ 5 303 <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> p <br /> PROJECT DESCRIPTION: X <br /> r <br /> This project is a new building or structure. 4 * �f : � <br /> ❑This project is an addition/alteration to an existing building or structure. t5 t 2 <br /> SANITARY SERVICE: PERMIT NUMBER: : @ 46.1 � : i' <br /> ❑SEWER ❑SEPTIC ?, �� 1 a(" <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) 3 r --� <br /> AREA TO NEAREST SQUARE FOOT: 14 ° <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: � 6 ���,,� <br /> 2- / (,0 4 TOTAL SQUARE FOOTAGE: �� tea- , <br /> 2ND FLOOR: 3RD FLOOR: 1 01 � � <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ " $ n f <br /> (p Z �@ �K t �.(Please round to nearest dollar) <br /> 2ty <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 Jo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? AYes ❑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 yNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ytNo <br /> APPLICA MUST BE SIGNED <br /> ► <br /> (Continue TION on Back) -o- -;• - <br /> 545-112(4/08) <br />