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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY.OWNER s:INFORMATION° :,,:, , •t,; _��,-z., .: ,�._. < z J: CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> BR IN�N 0 o �P,u�0)1t) ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> Loi ■ LO&#1V CA, rAMs 1 ., r 5 3 5 q 1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> uol L11 + - t/ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION ; CONTRACTOR INFORMATION." ' 1_ and includes dimensions <br /> AG NT NAME ^ ` CONTRACTOR NAME <br /> L II\vE Il�16 I 1 ❑ Site Plan including location <br /> A ADD SS CONTRACTOR ADDRESS of well/septic <br /> (Ci ,State,Zip) (City,State,Zip) �V ❑ Setbacks s, ss <br /> PHONE PHONE ❑ Site Plan approval from <br /> Goff— ki)SS- e5A5 applicable township: <br /> E-MAIL ADDRESS E-MAILADDR SS <br /> LD r tN9 i. ti 6Th. ► I . ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION ';(http:llaccessdane.co dane.wLusn Li Elevation of property <br /> PARENT PARCEL NUMBER: IFtiEgNTZ0 I NG: 7 b: ACREAGE: P P rtY❑ PARCEL 7 OI ►(-J�. (�, Ni frontage drawn to scale. <br /> NUMBER 0ciI2---3•-1-,-301O -L <br /> TOWNSHIP: SECTION: <br /> • bR ,/: 1/4%: ❑ Driveway permits <br /> ADDRESS::6 q ^l CAM, �� r (state,county,town) <br /> �+' r 1 V ❑ Sanitary permits <br /> CSM: LOTeo�I�sioN A \ BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION, U �,ll a <br /> PROJECT DESCRIPTION: / / � �rT � _�Itit LO <br /> ❑This project is a new building or structure. 1' <br /> • 9This project is an addition/alteration to an existing building or structure. r:; z, <br /> SANITARY SERVICE: PERMIT NUMBER: i' ' - :, <br /> ❑SEWER ❑SEPTIC a,,v7-f.. � '` " ` . i' <br /> . s:—_. x {y,;•y 1. <br /> HEIGHT IN FEET: ID NUMBER OF 5-DRIES: (Not including basement) -- <br /> AREA TO NEAREST SQUARE FOOT: -" <br /> (Outside dimensions including unfinished area,attached garaged and above grade decks or porches) s : * . <br /> BASEMENT: 1ST FLOOR: ®�� �a� � �� <br /> TOTAL SQUARE FOOTAGE: �' �I `rt `. - <br /> 2ND FLOOR: 3RD FLOOR: <br /> �J°�L1 e . <br /> ESTIMATED CONSTRUCTION COST a a'41 a > E <br /> (Please round to nearest dollar) -0 ""0 "'0 "'0 -0 "'0 $ t�A o 6� �� <br /> &Li <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ID Yes 2 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes L o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes , o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L`1 No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blankifinone) <br /> 6. Is a location survey required? (see reverse) i ❑Yes l3 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes L'1 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -i <br /> 545-112(4/08) <br />