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-ZONING PERMIT APPLICATION www.countyofdane.com `SUPPLEMENT-to Web-App# <br /> PROPERTY-OWNER INFORMATION": _u; ,' -;:: CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> a H n a LA r't`�-` ,4 I}"' ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,street,City,state,Z ) Deed Restriction;CSM <br /> Z-4 q g L.e I, - 51 OM`lttbr. ,It4T Variance(#. _ ) <br /> HOME PHONE CELL PHONE E-MAX,ADDRESS <br /> ■13 1 q 1 5 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION _ CONTRACTOR INFORMATION -: and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Se_ I P ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (CIty,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONN PHONE , ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADORESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER v$1/j Z a I " 15U 1 A- )E x 2,3 frontage drawn to scale, <br /> TOWNSHIP: SECTION: <br /> t) Us t v- , Z � '/a: k, 1/<4/a: s 1 ❑.Driveway permits <br /> ADDRESS: 1 (state,county,town) <br /> Z. L-1 'i C-S I I C- I� ❑ Sartitary permits" <br /> csM:7- $ LOT I SUBDIVISION BLOCIVLOT (public,private)} <br /> PROJECT DESCRIPTION: <br /> �� <br /> root^ , � '1-1."NsSe..e-. I~ovt- <br /> ,^ o o I _ <br /> ❑This project Is a new building or structure. <br /> [9 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER: t - <br /> El SEWER (i 'SEPTIC - - <br /> HEIL3HT IN FEED. NUMBER OF STORIES: (Not Including basement) <br /> I5 o. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT; 1ST FLOOR: ' t f <br /> 4 TOTAL SQUARE FOOTAGE! j =i <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: pc, <br /> (Please round to nearest dollar) � --0. --lb ' ' $ 1 '0 t CD 0 0 I • <br /> 1. The property Is within 300'feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. is there a wetland or floodplain on or near the property? ❑Yes 14 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,4 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property In the past 5 years? 0Yes , 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 <br /> 7. Is this to correct a violation? ❑Yes JE No <br /> APPLiCAuTION MUST BE SIGNED <br /> F1i112 WOO) (Continue on Back) ♦ ♦ -► <br /> ZOO f2 NO,LHO110,LS AO D 6T9S CL8 809 XVd rT:80 6002/TZ/20 <br />