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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App# <br /> PROPERTY OWNER.INFORMATION'+.- . ,,=__ ?kl� nt ;r, ,-:.._. r1:1i.= CUSTOMER TO PROVIDE <br /> OWN R NAME <br /> 4-$//Z.a car 774,.vi 4- 04-30 N <br /> OWNER ADDRES Number,Street,City,State,Zip) Deed Status;CUP; <br /> t ,yGd f 7g. m,q z v A-I4 A✓/i 4)r 5-3-r o Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE p CELL PHONE E-MAIL ADDRESS <br /> ` '11 Site Plan drawn to scale <br /> AGENT INFORMATION _ CONTRACTORjNFORMATION , 1 and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> P.I Err/fr I ti L 3 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ` 3 Setbacks �t )A <br /> NAT' , <br /> PHONE PHONE 4 3 Site Plan approval from i - <br /> applicable township.No P <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 9 Elevation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rtY <br /> PARCEER L O t',12--m g! 4 , /L-4 S y frontage drawn to scale. <br /> NUMB <br /> TOWNSHIP: SECTION: <br /> MA z G"1 0 ti i A, r IA: .1/4%: ❑ D�t <br /> sperm <br /> ( ta tyown <br /> )ADDRESS: <br /> G v 3 `1 H - y 7 X I'142-0 /1'119^')4:- cJ 1 5—.35-4• 47 <br /> ❑ Sanit ,[mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (puCC�ll'li ,��Fk'ate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: - , ..ar <br /> POLL /3 I b Al/1 L H i n'L- 5//1, 74®1° 0 . �- <br /> Et This project is a new building or structure. _ `� - <br /> ❑This project is an addition/alteration to an existing building or structure. ; " `°. _ j� <br /> SANITARY SERVICE: PERMIT NUMBER: l i r-x '. - <br /> ❑SEWER SEPTIC ,,,ik,. ' <br /> ' E u <br /> HEIGHT IN FEET: � NUMBER OF STORIES: (Not including basement) _ <br /> AREA TO NEAREST SQUARE FOOT: � r ; <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4i �' <br /> BASEMENT: 1ST FLOOR: '�# ® 1V - °r� <br /> 4, TOTAL SQUARE FOOTAGE: I �'�-�iz,4-.15::°,,� 3 T''',,`,:4 <br /> . <br /> 2ND FLOOR: 3RD FLOO' i O - �x <br /> ESTIMATED CONSTRUCTION COST e .6€ � <br /> ai4r 4 e®9a <br /> (Please round to nearest dollar) '* -+ .- -+ -i —°. $ Z�� ) :45, ,4':f�1„ _ u' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? a'es No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 2f 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? ,ZYes ❑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 lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -i <br /> 545-112(4/08) <br />