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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT:to Web-App# <br /> PROPERTY-OWNER tINFORMATION , �;;_ _ ' '.1; .1,44:c 01 , ; < ;- w CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1 <br /> .' \ci\C.5 M( t.11 ( 16.t. SC\■)■R ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> c-815 ct m . .•, , RO ‘NEDI‘)F\ u,t S-)„.9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> CBS-\a\ 5-L _ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION , .;, CONTRACTOR;INFORMATION,` ' >- ` - and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ' c:\ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Co c 1KIA(s0 IV <br /> (City,State,Zip) (City,State,Zip) n ❑ Setbacks <br /> PHONE PHONE `��~' ,W} 53559 ❑ Site Plan approval from <br /> ( ) 314 5_9-)c3 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.widuisl) : ❑ Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> P rtY <br /> PARCEL A.) 6/ ill f� u 5)P7 frontage drawn to scale. <br /> NUMBER (,� 1 <br /> TOWNSHIP: SECTION: <br /> ,/4; ,/,/: ❑ Driveway permits <br /> ADDRESS: ) (state,county,town) <br /> �S1'5 C \w\(5o �o SUBDIVISION n1& '»i C31q ❑ Sanitary permits <br /> CSM: LOT LO K/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION, <br /> T 3� <br /> PROJECT DESCRIPTION: _ _ +4 ' <br /> )uX cP\a C KR116E i 4� err <, <br /> ,`a`+ k-4 r - 'tea . <br /> • .1 This project is a new building or structure. vr_ g`y ; <br /> ❑This project is an addition/alteration to an existing building or structure. z; ; tom; -9- <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> t��¢� e ar r <br /> ❑SEWER ❑SEPTIC : 13P. 4s <br /> r <br /> HEIGHT IN FEET: V NUMBER OF STORIES: (Not including basement) ' ` <br /> / apt P ads; �F®i-i~.' <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:° �'`�e ° � � <br /> 4, TOTAL SQUARE FOOTAGE: , ; �T. k. -ile :'- , ' <br /> 2ND FLOOR: 3RD FLOOR: <br /> -tY 1, <br /> ESTIMATED CONSTRUCTION COST: \t O '"'R�$ <br /> (Please round to nearest dollar) ♦ ♦ ♦ "♦ � � s«� <br /> x � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes rJ No 0/Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes ❑No CJ Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? CI Yes 1:1 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) jYes ni No ❑Don't know <br /> 7. Is this to correct a violation? Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />