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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION .:., ,; '' ' 1-0, .. =,,-.-` t,,.__.'- CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> i 0 1 10 'bCJ \---\ t L 17- ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Str et,City,State,Zip) Deed Restriction CSM <br /> D-, 6 '7 q c-t P� p /)2/ 1- t� %) 53-j`)� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAt ADDRESS // ] J �,� <br /> 37-�Z07 /;08-6 2-5--- P.7 /1, i Lr inA4-C , 11 4 l� Site Plan drawn to scale <br /> AGENT INFORMATION , - ' CONTRACTOR::INFORMATION';:? •+ and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C <br /> /eQP7 ' 'f /411 H y Lfd'Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> / `IO /all 0L / g T <br /> (City,State,Zip) (City,State,Zip) U Setbacks <br /> ✓erorra) A31 c?cf3 <br /> PHONE PHONE ❑ Site Plan approval from <br /> fide. — 3 73 - 3-5-5-6 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS , ,, � <br /> ID'�loor plans to scale <br /> PROPERTY/LOCATION:INFORMATION ':;(http://accessdane.co dane.wi.usn cet!'----- <br /> ion of property <br /> PARENT PARCEL NUMBER: CURRENTZONI ACREAGE: P P rty <br /> ❑ PARCEL t60-7 9V%D 6 0 frontage drawn to scale. <br /> NUMBER � �._ , �� <br /> TOWNSHIP: SECTION: <br /> r 1/4: s6 %%:. ❑ Driveway permits <br /> ADDR S: -\ 1 (state,county,town) <br /> 2e1 Cl �cY n t—� ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION. Vr ' - <br /> PROJECT DESCRIPTION: Y ; <br /> D netI-t�J Sl+ cD ;gin -i ,- ,. { <br /> "This project is a new building or structure. , m <br /> ❑This project is an addition/alteration to an existing building or structure. 1:.#� r� V- <br /> SANITARY SERVICE: PERMIT NUMBER: r <br /> ❑SEWER ❑SEPTIC 'i4 <br /> HEIGHT IN FEET: V NUMBER OF STORIES: (Not including basement) �' ya , � <br /> AREA TO NEAREST SQUARE FOOT: :-: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' ,„ ` t , ka f <br /> BASEMENT: 1STFLOOR: �.0 ®�� n ��� <br /> �� I 4, TOTAL SQUARE FOOTAGE: 4 ��-- ur. : . <br /> 2ND FLOOR: 3RD FLOOR: 4 " - :, :;1:-.;,t0---4,,- <br /> -- L — 72o Ft � y <br /> ESTIMATED CONSTRUCTION COST ♦ -► --► ♦ ♦ -i $ G�D T p F:1.r s <br /> Please round to nearest dollar (J . : , x• <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ... ...... ❑Yes IgNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes igi No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreem t> .. NtYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years?.. ...4.... ,l.Yes ❑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 14No <br /> � 0-a APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -0. -► <br /> 545-112(4/08) '70 <br />