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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID i..„.,OWN AME ^� <br /> C�?ertt 7.-52 ‘ V //z Zoning Status;CUP; L <br /> OWNER ADDRESS (Number,Street,City,State,Zip) f Deed Restriction;CSM <br /> -/ > 0 7 C7 f 4'y � (__/v_55�/1/4S (.)/ J-35-,--", 1/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0'1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONP/ ,2 > r CTOR NAME <br /> C7—e9 G, // /I AP1 //</^s l� e_ including Site Plan includin location <br /> AGENT ADDRESS CONTRACTOR ADDRESS , of well/septic <br /> 4/ it J / .d/4f I313° )° <br /> (City,State,Zip) (City,State,Zip) _ Setbacks <br /> (,)k v/7i`/cL-e /t�/ _5$) ''7 l)4 ii/k kv f e✓/ $-�.5 /7 <br /> PHONE PHONE Site Plan approval from /A, <br /> 1 /9— %7 U Y L/1_ ?70 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> e a r)e ;i7 . a 6 k r P 6 .E-e/5• /L e Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usf) ('Elevation of property <br /> PARENT PARCEL NUMBER CURRENT ZONING: ACREAGE P P ►ty <br /> ❑ PARCEL 7 /L // j t,.� frontage drawn to scale. <br /> NUMBER 42707-ioR - 6/'/ oL, ! <br /> TOWNSHIP: SECTION: ,, <br /> ' ,5 <br /> 0 6_15 P/C/.1 _3 /0 1/4: '/4'/4: P Driveway perm' C tl <br /> ADDRESS: (state,county <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION !-r-4.4.17- 7-1--1117 <br /> p <br /> PROJECT DESCRIPTION: <br /> NeCJ �71 C 02 °L <br /> 'e �.- ;:✓mss- 7 R ut v F I <br /> N <br /> is project is a new building or structure. 4, ; <br /> ❑This project is an addition/alteration to an existing building or structure. 2w- <br /> SANITARY SERVICE: PERMIT NUMBER' �� ,: e ' <br /> lid❑SEWER IC ; 4 , <br /> HEIGHT IN FE v` nom" <br /> FEU., NUMBER OF STORIES: (Not including basement) _ s <br /> /� z :: <br /> (.% AREA TO NEAREST SQUARE FOOT: <br /> � i .Outside dimensions including unfinished area attached garages and above grade decks or porches) � i " <br /> "4 t - <br /> , r <br /> BASEMENT: 1ST F OQt-4: -" � <br /> / ? / /,,,y// j TOTAL SQUARE FOOTAGE: j a <br /> 2ND FLOOR: 3RD FLOORS 1 <br /> ESTIMATED CONSTRUCTION COST YO , * °4 <br /> (Please round to nearest dollar) —• -�► —• ". ". '♦ 00 0 -: 4 4 : <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 191Go ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes laN ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q1'es- ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes fo <br /> C <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# <br /> ,)__) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No L -Bor (know <br /> 7. Is this to correct a violation? ❑Yes Qtdo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -.► — <br /> 545.112(4/08) <br />