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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App# <br /> PROPERTY-OWNER::INFORMATION r; ,,,,__,> '4,-3, 4 ;a0,:;i ..=,_:-c ;.','. -: CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �e5!/4 C c f32oS • ❑ Zoning St:ucsti, , <br /> O NER�yADDRESS (Number,Street,City,State,Zip) De a on;CSM< b VNitc�iu gD &oc k/yn' (�r,S 5-5 z V Ce ) <br /> / HOME PHONE CELL PHONE E-MAIL ADD ESS <br /> bog -y55- 1357 bog-225- gZS1 <br /> Site Plan drawn to scale <br /> AGENT INFORMATION _:; CONTRACTOR INFORMATION ,, and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> a�n Q,t& l ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 7 well/septic <br /> (Ci <br /> t . <br /> , tate,Zip) _Cli � <br /> (City,State Zip) <br /> Setbacks <br /> PHONE <br /> PHONE ❑ Site Plan a oval from <br /> applic a township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ oor ns to scale <br /> PROPERTY/LOCATION'INFORMATION..;(http:llaccessdane.co dane.wi.usn Elevation of property <br /> PARENT PARCELNU ER: CU RENT ZONING: ACREAGE: P P rtY <br /> Li PARCEL a V/ ', 3 / .‘8)0 /- 0 A„ ' r x </t. 01 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: S TION: �- <br /> 0/24-.6 C3,ti 1/; n) 1/1/; N 4. ❑ Driveway its <br /> ADDRESS: (St ounty,town) <br /> ❑ Sanitary•- its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pub' ,private) <br /> PROPOSED PROJECT INFORMATION; - � <br /> PROJECT DESCRIPTION: r s <br /> ❑This project is a new building or structure. ~ <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ;,iI�'i- 'f7 ,r <br /> ❑SEWER JCJ SEPTIC �s I�.� - '� ` { <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ` , <br /> 1FI1$ obi' ' <br /> AREA TO NEAREST SQUARE FOOT: a � {! � <br /> (� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �''ul 1 <br /> BASEMENT: 1ST FLOOR: a e � � r � <br /> 5--7 57/ . TOTAL SQUARE FOOTAGE: ��� m�-a`'4 .? <br /> 2ND FLOOR: 3RD FLOOR: C7 '7TH <br /> 1 15 ESTIMATED CONSTRUCTION COST: i1 ® y,p - <br /> (Please round to nearest dollar) 350�� .*,,a-,.....,_ - -" ,� ,: <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes C'rNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ErNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes Opie <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 ErN ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> f ? r APPLICATION MUST BE SIGNED <br /> / v �( (Continue on Back) -+ -► -► <br /> 545112(4/08) <br />