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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#. <br /> PROPERTY OWNER:INFORMATION`.., _ . :__ _14 ,';A,,ti ',-: <br /> o ER AME I '"_'"�=_"�� `'� �'="� � CUSTOMER TO PROVIDE <br /> OW ER Vu S 3e- I / <br /> 5-353/ ❑ Zoning <br /> Status;CUP; <br /> OWNER ADDRESS (Number,StreekcL.ty,State Zip) Deed Restriction;CS <br /> M 17f5 n l,,d e State, (I VI <br /> Variance(# ) <br /> /HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 603 g73-7 S ❑ Site Plan drawn to scale <br /> AGENT INFORMATION ::; CONTRACTOR'INFORMATION = , r and includes dimensions <br /> AGENT NAME CONTACTOR NAME <br /> Fred o se/f C ie41-/ Do '�(v17S ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR'ADDRESS of well/septic <br /> /7 t/5-AnCitt & 190 J' /,. 5 " • <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Dee/4/e/d WI .5353/ Vecoel c (,v7 535"-3 <br /> PHONE O7 PHONE ❑ Site Plan approval from <br /> log` a v— J5`3 i g -373 -5-55-0 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION:INFORMATION.(hUp://accessdane.co.dane.wi.usa ❑ Elevation of <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: property <br /> UMB <br /> ❑ NER 0LibO Llb/a2-$o5 -7 A - / ex /Q./g frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Pltegsgn-t- SprirA J 5 / a 1/4: I(f //: N ❑ Driveway permits s <br /> (state,county,tow <br /> n)ADDRESS: <br /> / 7 q p , d e., /Pd- )e e l Il e I d 6)t 535 31 ❑ Sanitary permits C M: <br /> LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION. �i -- l N-4 PROJECT DESCRIPTION: I `- ca? 42 ' E _ , : <br /> Qti <br /> o /e 8u i 'd i hA -P\Fiz t CU t_T,t-zA-L. U5 cS �" t l u <br /> 1-This project is a new building or structure. 3(c'X �`4 i- ' N �` <br /> This project is an addition/alteration to an existing building or structure. f <br /> ., s T <br /> x <br /> SANITARY SERVICE: PERMIT NUMBER: ��$ € e �_ <br /> , : � a❑SEWER SEPTIC <br /> HEIGHT IN FEET: V NUMBER OF STORIES. (Not including basement) ,- <br /> / <br /> AREA TO NEAREST SQUARE FOOT: <br /> ii.t4t—, :._.:(Outside dimensions including unfinished area,attached garages and above grade decks or porches) l : . : <br /> BASEMENT: 1ST FLOOR: -�. ®-1.,----'4 -�� <br /> /_ / . TOTAL SQUARE FOOTAGE: ,�, -4 ', <br /> 2ND FLOOR: 3RD FLOOR: <br /> (p / �1�/�/�%/ �j � �t` � c <br /> ESTIMATED CONSTRUCTION COST: /� ` <br /> ( ) ♦ --► --► --► ♦ $ SO +� ® a e 4� <br /> Please round to nearest dollar 3 S . � ;. , <br /> 2Z <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes )4No Li Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes A No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No is <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 ArNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes XNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />