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RECEIVED <br /> • . 1 <br /> ..S to <br /> UPPLEMENT- Weo-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com illnileff <br /> .., ,. . <br /> PROPERTY.OWNER.:INFORMATION ,,; ., _ .0 4,"y 0.: 4_.-,'- fit;;; ' = CUSTOMER TO PROVIDE <br /> OWNER:i-(1)e-vf' Y 4- eei c-tS� ❑ Zoning Status;C <br /> OWNER ADDRESS (Number,Street,City,State,Zip) • I g ' UP' <br /> f clq Deed Restriction;CSM <br /> �v1�1 P'l e put 5 .r3 1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADD S <br /> 1 (1 (q7,-7v 6i Ce ( A. , - 144A - ` 644.kt e k ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR;JNFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR DRESS 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/) . ❑ Elevation of property <br /> PARENT PARCEL,NUMBER: CURRENT Z•WING: ACREAGE: oP P y <br /> ❑ NUMBER Calif Oj 9 j Z — (q 2.-,(o8�p Al frontage drawn to scale. <br /> coTOW IP: SECTION: ❑ Driveway <br /> 1)-ek—. ev , '/a: '/.'/4: y permits 4 <br /> ADDRESS (state,county,town) <br /> `n ❑ Sanitary permits ,/ <br /> N) CSM: LOT SUBDIVISION BLOCK/LOT (public,private) ,/V/j, <br /> /1 LeA . 3 <br /> PROPOSED PROJECT INFORMATION;;! - <br /> , T ~ ��� t ` �- <br /> PROJECT DESCRIPTION: �s�1R t/ //��II � c <br /> i i' " J. <br /> 6 This project is a new building or structure. c �� <br /> ❑This project is an addition/alteration to an existing building or structure. 1 , ,,- t' v <br /> SANITARY SERVICE: PERMIT NUMBER: e 4 A <br /> ❑SEWER ❑SEPTIC 13 �� Br W " <br /> HEIGHT IN FEET ^} (( ice N BER OF STORIES: (Not including basement) v : <br /> OF <br /> AREA TO +h•REST a UARE FOOT: <br /> (Outside dimensions incl ding unfinished area,attached garages and above grade decks or porches) ° ". , <br /> BASEMENT: 1ST FLOOR: .. .,e ,.k Pb � F , <br /> j, TOTAL SQUARE FOOTAGE: j $e 4_,,, ' <br /> `V•`K s. <br /> 2ND FLOOR: 3RD FLOG ' <br /> L3 7/ <br /> -i t ESTIMATED CONSTRUCTION COST. : , g l .i(Please round to nearest dollar) ! Q♦ G p V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes LS(No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? L Yes ❑No ❑Don't know 4()4- <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑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 ❑No ❑Don't know (.iylti <br /> 7. Is this to correct a violation? Citces ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />