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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App# <br /> PROPERTY OWNER`.:1NFORMAT,ION'z z; __ --'.=.,. t� �: ; , ,:r, .._, �., ,, `. CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 3g3 .S i EVEN T>�- Deed Restriction;CSM <br /> Variance(# ) <br /> •1176RE PHONE CELL PHONE E-MAIL ADDRESS t <br /> 608.2`l`4 /Lft, in�a®eei/G� '/owl/-Gawt <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION , .;,- - , CONTRACTOR:INFORMATION r , ;;:;,_ and includes dimensions <br /> AGENT NAME CONTRACTOR NAME r <br /> 44/ P&ORVA/S ge Vre ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> au s2 Gi+y Pti Pt4 <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Oi 60,V 1A// ,C3 3 <br /> PHONE PHONE ❑ Site Plan approval from <br /> t90 8. 3C43. 3 8 9 f applicable township: <br /> E-MAIL ADDRESS E-MAIL RESS <br /> ,taeD@ Lvnse rCot s Zrvth.Gaa. ❑ Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION'.:(http://accessdane.co dane.wi.usn! ' ❑ Elevatiof <br /> PARENT PARCEL NU BER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑ NUMBER o,y o8Io_032/t- `o � Z— • 793 frontage drawn to scale. <br /> TOWNSHIP:„.. oZ• 110.jv/Q Krc 4: 1/1/: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> • <br /> 3 g8© S7&VE-Pk) Dad ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION, 1 _ TA V a f6F f' <br /> PROJECT DESCRIPTION: <br /> I L t ij °' p c° --,4-.-::-L <br /> ❑This project is a new building or structure. <br /> � ?£fi ” 1 k <br /> CI This project is an addition/alteration to an existing building or structure. - ;_ &s� z <br /> SANITARY SERVICE: PERMIT NUMBER: r�� i 11` °o Pi� -7- - ? : <br /> El SEWER ❑SEPTIC s t i ��, <br /> - ._rte <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) s � > <br /> ® , 4€� �"" tea <br /> •AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) k„ — , <br /> BASEMENT: 1ST FLOOR: 6�. 9„ 'r� ,, <br /> 4, TOTAL SQUARE FOOTAGE: j p's al °� "' <br /> 2ND FLOOR: 3RD FLOOR: : 2 <br /> X42. <br /> �4, a <br /> ESTIMATED CONSTRUCTION ' <br /> _ ® 4 s <br /> -0 ♦ -► ♦ -i ♦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 ❑No ❑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'? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aroe) <br /> (Continue on Back) —► —► —► <br />