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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N M _ <br /> 1' /, // /U / g <br /> ��"y.C� S �•O�' � ❑ Zoning Status;CUP; <br /> OW RA DREESS (Num• •et, ity,Sta- • Deed Restriction; CSM <br /> 7 / C / / ' of."--k- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4-5"- 60.1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR COMTc0:11E <br /> , l/.� ❑ Site Plan including location <br /> AGENT ADDRESS CONTRALTO D 'SS ,yam of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> (,‘-)/ -* <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6o c - 7 70 .Q 96 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS t lie--4'/I-∎ - OQ„d Q / S 1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane,co.dane.wi.us/) <br /> PARENT P CELNUMBER: CURB NT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL ,l! �i f f_a _0 / 9 3 Q U frontage drawn to scale. <br /> NUMBER O ! / 7 <br /> TOWNS / SECTION: _� <br /> ri / / 1/4:?y 1/41/4• /` ❑ Driveway permits <br /> ADDR SS: <br /> (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT 35S TO rt"4- <br /> .N-E5 1L€ j.S AV P-o-t> s 'rt,.'E 1.4)„,r44 ❑ Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBE F ORIES: (Not including basement) <br /> / o2 / / ❑ WetiandiFioadpiain/ <br /> AREA TO NEAREST SQUARE FOOT: r'hDr @lantf (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ EroslonCntrt�I permit <br /> i /�� //� D 4, TOTAL SQUARE FOOTAGE: ,` (slopes,,disturbance <br /> I( V Q Sq, ��� fillingta c ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> i <br /> y/ ❑ Review Location Survey <br /> ESTIM ED CONSTRUCTION COST: ♦ -•► ♦ ♦ ♦ ♦ $ �, • ob and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes OQNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? .a❑,Yes 11A No ❑Don't know <br /> l <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑va <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes UNo <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if�ne) <br /> 6. Is a location survey required? (see reverse) ❑Yes Joo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 2.fio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />