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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> - PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME /,� <br /> S G'W n Ag t LS ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,S reef,City,State,Zip) Deed Restriction;CSM <br /> 72 7 /V/`�j �—,i1 q�1-e �✓1/ Co (�� U�� IA �3�27 Variance(# ) <br /> HOME PHONE -/ CELL PHZiNE E-MAIL SS <br /> O '-751-13 // - 11 std'-s 4-2./S- 11`■ / car? ❑ Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 7 F VED ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS " of well/septic <br /> (City,State,Zip) (City,State,Zip) DEC 1 8 2015 ❑ Setbacks <br /> PHONE PHONE Site Plan approval from <br /> rya{F1P r+n4r� r:l,�t,�,,►4,� jj�� „�+^,�,-.E>~p applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: <br /> CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER 0/ S/O711-05Y 227f-d R l e II 7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> `.(`a1.✓✓I o� Co � -�- 6 r o 0741/E°•s 1/: INN: El permits <br /> ADDRESS: ✓J (state,county,town) <br /> 27271�r�a�l Lh C� c, G'ror e 1-1/ s3-c-2-7 <br /> CSM: LOT SUBDIVISION/ BLOCK/LOr El permits <br /> 21 1 (public,private) <br /> Rave , ,ode rS ^t-?S <br /> PROPOSED PROJECT INFORMATION T PREV P,y 41.4,:;. <br /> PROJECT DESCRIPTION <br /> S S (Ec• �i Tf �oi N.to $e�� nwr Eichprl'n fio 1S ms►vy$� J ��r0.q� �t� ! / l 3 <br /> • CS,This project is a new building or structure. @ i,* .- s <br /> ❑This project is an addition/alteration to an existing building or structure. ; <br /> SANITARY SERVICE: PERMIT NUMBER: r..» ®°7 '" <br /> E1SEWER SEPTIC w `''� .:I� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ,,4 ;, ,� ` <br /> AREA TO NEAREST SQUARE FOOT: = <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) yy <br /> BASEMENT: 1ST FLOOR: <br /> / <br /> __ 1// >(, 1 2 ,,, TOTAL SQUARE FOOTAGE: `� •�. <br /> 2ND FLOOR: 3RD FLOOR: l l 2 S 4-) /�(l c <br /> ,',--<.� '�F`•gyme`if['6-'-- pi 0 t T <br /> ESTIMATED CONSTRUCTION COST: rQC. C l'tcjr ilia <br /> (Please round to nearest dollar) �� �.:- w - <br /> 1. The property is within 300 feet of a stream or 100 feet from a pond or lake? Yes No Don't know <br /> gl <br /> 2. Is there a wetland or floodplain on or near the prop rty? ['Yes No ❑Don't know <br /> 3. Have you talked with the township about your proj ct and are they in agreement'? El Yes No <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? ❑Yes O NO <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No Don't know <br /> 7. Is this to correct a violation? , Vi Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -► -► <br /> 545-112(4/08) <br />