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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME 1n �j /�/� CUSTOMER TO PROVIDE <br /> o phe I 7 c I ❑Zoning Status; CUP; <br /> Num er,StreetjCity,State,Zip <br /> 0� I V`a 0-e ( \ ^ r Deed Restriction; CSM <br /> 1'�.' u��• �{ PUi l�{ V V ( �J*�T� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDR-oS <br /> VI Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AG NT NAME 11114 1� 7•• •- �/� <br /> 6 1011/,i ' ills l`;�ttr]i�, PI Site Plan including location <br /> NT ADDRESS . ' CONTRACTOR ADDRES of well/septic <br /> .I /. d V ® ' ! • ,�. 1/ At 1 -C <br /> /A . <br /> ,State,Zi.) ( ' tate,Zip) Setbacks <br /> A U/1 ► Id. • ♦ a ► f._,•11 <br /> PHONE I - PHONE j Site Plan approval from <br /> (r-05a 4'61— Lc t ( (Q) --1 ( '1 o1 applicable township. <br /> E-MAIL ADDRESS E-MAI,L ADDRESS <br /> Y\C ; 7!*i ,l , II' A•-- , ) LJ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessw.'4ne.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ® Elevation of property <br /> El PARCEL NUMBER - 7 -zit-12, 14 lei ID . r frontage drawn to scale. <br /> TOWNSHIP: i /� \ SECTION: <br /> { lam, 11(•O C' 1/<: '/41/4:_t LA Driveway permits <br /> \./4 1 ` (state, county,town) <br /> ADDRESS: r l 8 -o Z" ` . P l ( Sanitary permits <br /> CSM: LO BDIVISfON BLOCK/LOT <br /> (public, private) �6/ <br /> PROPOSED PROJECT INFORMATION -4 <br /> PROJECT DESCRIPTION: <br /> _C-7 V ' :`AsIstAliil.-.*.i'*f.s';''S'4*V„Sis.WI:s9.i4 f•:•',°sr:,; <br /> . This project is a new building or structure. ; .. <br /> This project is an addition/alteration to an existing building or structure. * L �. `f <br /> SANITARY SERVICE: PERMIT NUMBER: ,y-� �s - <br /> EWER PEPTIC 1?��?d(LO (5 2c7' b �. °.! a <br /> HEIGHT IN FEET: J'JJ��� NUMBER OF STORIES: (Not including basement) .s '.S �` <br /> r <br /> ' r N''',4:'y_� a , <br /> AREA TO NEAREST SQUARE FOOT: iri " 4' .<.-, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � ,;g.x y , <br /> BASEMENT: 1ST FLOOR: _ "_x f <br /> (11. 1 � <br /> j - c + TOTAL SQUARE FOOTAGE: + '' . . ',4 ,V!•,'' _ <br /> 2NDFL0 3RD FL••R: _ ' `4 tj° h 4: x <br /> $ F z i <br /> ESTIMATED CONSTRUCTION COST: n3F <br /> (Please round to nearest dollar) 1�01- co l/ ;;, , s .'+ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es to <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 <br /> 7. Is this to correct a violation? ❑Yes RINo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ ■ -+ <br /> 545-112(4/08) <br />