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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER.INFORMATION.`J.;;: __ We V�,;: .e.:-r-, , -', ' CUSTOMER TO PROVIDE <br /> 13 1/td —Mal L CP • ❑ Zoning Status;CUP; <br /> OlnhvR ADDRESS umber,Street,City,State,Zip /�,,, I <br /> �0S (`]G L� �w)atut es M IV j S- ' Deed Restriction;CSM ) <br /> HO�RE PHONE CELL PHONE E-MAIL ADDRESS 7 �4 Variance # <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION._. , CONTRACTOR:::INFORMATION ? and includes dimensions <br /> rAGENT NAME �/� CONTRACTOR NAME, H <br /> I ipt-&f/ IP 0,"(�C G94...• ❑ Site Plan including location <br /> AG T ADDRESS .� RA TOR ADDRESS of well/septic Oufior) ,Or (a, ;7 <br /> (/�h�ip) (Ci,,State,Zip) Setbacks <br /> I.� SJ ' GO ,S ' , I I I CI' WI Arm, ` l <br /> PH cj •"O E �� ❑ Site Plan approval from <br /> "1 �� ' I � U) O1 applicable township: <br /> E ILADD-1 E- AIL ADDRESS <br /> i '-,J k 0 0 ' QOM/ - ❑ Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION!::(http://accessdane.co.dane.wi.usn <br /> PARENT P CELNUMBER: t/i- CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL 10 6l q._g y frontage drawn to scale. <br /> NUMBER <br /> TOWNSHy� SECTIO <br /> /�� ( �]� n l 1/4: 6 %%..A26 ❑ Driveway permits <br /> ADDRESS:"""/��JX ( J�j� / (state,county,town) <br /> • <br /> 1 S� a' " U `6 ' /i A ❑ Sanitary permits <br /> CSM: / 3 Z LOT SUBDIVISION BLOCK/L jT_ (public,private) <br /> PROPOSED PROJECT INFORMATION. <br /> PROJECT DESCRIPTION: ',44.' ,:.1-'4%.:72,"" <br /> '3 „, . <br /> 7'-fir-4- . <br /> ❑This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. -` <br /> 9 9 .rte .4' ' <br /> SANITARY SERVICE: ij fA-r 'F �'- <br /> PERMIT NUMBER: � �1r��a�rF"T��� 4 <br /> ❑SEWER ❑SEPTIC Nom * --ti _ ': <br /> HEIGHT IN FEET: ' 1' 5 5" <br /> NUMBER OF STORIES: (Not including basement) ;- <br /> UaOiCaS <br /> AREA TO NEAREST SQUARE FOOT: � �" y .4 °� 4-04°. 0 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t � <br /> BASEMENT - 1ST FLOOR: ° ® � <br /> 4, TOTAL SQUARE FOOTAGE: + r ss o -- � E. <br /> 2ND FLOOR: 3RD FLOOR: <br /> x, 5 ' v ,_ g <br /> �� `S�c 4 <br /> vier' 1°t , <br /> ESTIMATED CONSTRUCTION COST: <br /> t a♦ ♦ . ♦ . 'P ` :(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? LI 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) CI Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -* —► _■ <br /> ( ) <br />