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• <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Aw,E R,. ewsfc tr <br /> O ER ADDRESS (Number,Street,City,State.Zip) ❑ Zoning Status;CUP; <br /> t al,Q3 ' f, 9 Ltive p 12. L.4..91.4 Deed Restriction;,7 <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# S.S.-�I�J ) <br /> AGENT INFORMATION CONTRACTOR INFORMATION LI Site Plan drawn to scale <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAME <br /> AGSNaTADDRE� (. S�_,4 ' 4 ' e- r-- LI Site Plan including location <br /> CONTRACTOR ADDRESS of well/septic <br /> 12-8 Erw;(s p., si--• J Dfso4 s370; <br /> (City,State,Zip) (City,State,Zip) LI Setbacks <br /> y2.- toz <br /> PH NE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS tt E-MAILADDRESS <br /> U <br /> AT- G. ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.ust) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: LI Elevation of property <br /> LI PARCEL n <br /> NUMBER OZSIo(o/!.,-•27rg0]ir-T e377 s,f; frontage drawn to scale. <br /> TOWNSHIP: SECTION <br /> —P k h h �3 SW/4: 5e I/%: i o e u ❑ Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> CSM: LOT ��S ❑ Sanitary permits <br /> SUBDIVISION BLOCK/LOT <br /> / <br /> I, -C-- (public,private) <br /> PROPOSED PROJECT INFORMATION ' <br /> PROJECT DESCRIPTION: - ' 1 `s" <br /> l4:4:`,$4:',...;,,. r <br /> • his project is a new building or structure. <br /> LI project is an addition/alteration to an existing building or structure. `° tgat <br /> SANITARY SERV PERMIT NUMBER: ) =r mT`, , - <br /> SEWER ❑SEPTIC M r <br /> HEIGHT IN ET 30 C NUMBER OF STORIES' (Not induding basement) ' 1r oh 4n.4461.0,,,4;t0, <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASE E. : 1STFLO*— _ �: r e `e <br /> a • Z3'Q ,, TOTAL SQUARE FOOTAGE 1 r e: : r <br /> 2ND LOOR: 3�/rR�D FLOOR: 0 a °` <br /> ---"-r i�� Pon �Q -� r` 57V `G d'P.' 40t15'I'iffill'Ar-,V4111:' <br /> ESTIMATED CONSTRUCTION COST: <br /> 1 ,i,:::?!&244-gitV S, - ' <br /> (Please round to nearest dollar) "■ "■ -► '► -► -► 7 .C"oo� '/_ - r•, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es LI No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LJ Yes krNo LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# <br /> - --- -p ) (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 llo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -•► <br /> col'' <br />