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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App# <br /> PROPERTY OWNER;.INFORMATION i ._ __.-, ? 0.0, .% .-:.=`-=:-,.•:"':-.,:f ?-*- :w: CUSTOMER TO PROVIDE <br /> OWNER NAME/ <br /> / (/5-6#1. <br /> lsf(ne.,. 44 . , b04t /GSE-Cti <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ Zoning Status;CUP; <br /> Ag 7 fie r X&at s'1-- -Madison n 101 5 3 7 1( Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> `-11-3 24"7 (e9--/ 7 ii) ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION :'. , ; ..; and includes dimensions <br /> AGENT NAME CONT R NB"E <br /> Or TO FJrow// ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2 V'3 3 &,,-Xa,,,S� • <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> rkt e -1 c, t 4t1' S3 7// <br /> PHONE PHONE ❑ Site Plan approval from <br /> 72 Z - /7 Z v applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ---- ❑ Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION ;(http://accessdane.co.dane.wi.usn ❑ Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P ro e Y <br /> P rt <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER 02.4//0&/0 O02-6o3 3 B I <br /> TOWNSHIP: SECTION: <br /> b 1/4: t vJ 1/1/: S-� ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION, , <br /> PROJECT DESCRIPTION:/ /-, ._--, � ' -'- ,„7 t- <br /> 1 Z I A a 7 L, „ v� 7,-,, r 7_I 5 7Ci✓col5.� �„ - a, as ' n <br /> ❑This project is a new building or structure. - P 00, <br /> ❑This project is an addition/alteration to an existing building or structure.;- _ <br /> SANITARY SERV PERMIT NUMBER: r .'. 4°rr <br /> Y�SEWER ❑SEPTIC ' ' S <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: ' ; <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` <br /> BASEMENT: 1ST FLOOR: . e f � <br /> C J TOTAL SQUARE FOOTAGE: 7 , , ' °� E d <br /> 2ND FLOOR: 3RD FLOOR: ;s , / s& �H .i':.5. -k. <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 1 - -® �g m i ` <br /> (Please round to nearest dollar) `� 0 �' �' <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 - 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? ❑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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> ZZ <br /> 5-k--; APPLICATION MUST BE SIGNED <br /> `'`i <br /> 545-112(4/08) (Continue on Back) --0. -► -► <br />