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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web..App# <br /> PROPERTY OWNER`.:INFORMATION°,. „ _ '1=10 4 4 �, <br /> ��`, `' <br /> � u °` CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1 I I Aa.-t( Y AX euy ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Slate,Zip) Deed Restriction;CSM <br /> It n$1'1 C- € 1 ( k_ L (,�1 Variance(# ) <br /> HOME PHONE CELL PHONEAILADDRESS <br /> A,,, 10 I-Y. 0 CUUm,4 , , „ . • 911 Site Plan drawn to scale <br /> AGENT INFORMATION:-_:: CONTRACTOR:INFORMATION • „ and includes dimensions <br /> AGE •ME CONTRACTOR NAME <br /> COI2-4E-ET f-S L_ ❑ Site Plan including location <br /> AGENT ADDR- S CON ACTOR AD SS of well/septic <br /> Rio.. aX `-k5L4kO <br /> (City,State,Zip) (City,State,Zip) ` ❑ Setbacks <br /> Y r 1 kh b etb� <br /> PHONE PHONE ❑ Site Plan approval from <br /> X33 - a S-71 applicable township: <br /> E-MAIL ADDRESS -MAIL ADDRESS <br /> e_6.0 cLK,Tt`t 6 es . , Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:1/accessdane.co4ane.wj.usl) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P dY <br /> ❑ NUMBER O 708 -O 81 -?1(06---i frontage drawn to scale. <br /> TOWNSHIP: SECTI N: i i C. permits <br /> ,nn I0�Z_.CO� /; M� /se 0 ❑ Driveway <br /> ADDRESS: 1 1 (state,county,town) <br /> liSl` ' ",m L k _ ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> ,. ZT •�ASS <br /> PROPOSED PROJECT.INFORMATION i':;: <br /> PROJECT DESCRIPTION / Na:::-": ��7 3 r <br /> 11 This project is a new building or structure. F � <br /> ❑This project is an addition/alteration to an existing building or structure. 4s :4 <br /> SANITARY SERVICE: PERMIT NUMBER: �°N a a F F 4 .: <br /> ❑SEWER SEPTIC '- ,a i ' ' <br /> HEIGHT IN FEET NUMBER OF STORIES: Not including basement) ,.-' , , ' <br /> AREA TO NEAREST SQUARE FOOT: ., 7 <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) `.W :,11:w„ <br /> BASEMENT 1ST FLOOR: _ a e! l e� F0 ��� <br /> '1 I O �`�7 4, TOTAL SQUARE FOOTAGE: ,l t'e �s"I- , , <br /> Q� � <br /> 2ND FLOOR: 3RD FLOOR: n <br /> 157-7 5 9 9 7 �� .N .,$ r <br /> ESTIMATED CONSTRUCTION - . -- -+ - - $ ) 0tO ffi . a a i <br /> (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 o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 124o <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 -g.No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />