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ZONING PERMIT APPLICATION www.countyofdane.com .SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION ,? ;'.-'g vat '4' .i.�:� r t 1_` CUSTOMER TO PROVIDE <br /> ON/ER NAME / <br /> 7(G v e- &r— i ❑ Zoning tatu -UP;OWNER ADDRESS (Number,Street,City,State,Zip) g <br /> Peed R Iction;CSM <br /> ‘18—1-1 g -S r(f 1: 00 !c/r t_ 6,-c'ct W,' �/ar' ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS I <br /> 7( - '16 ,C' d ite Plan drawn to scale <br /> AGENT INFORMATION>-.: - ..;< CONTRACTOR:;INFORMATION`= _,= land includes dimensions <br /> AGENT NAME CONTRACTOR NAME 11/ <br /> Jh i et �f/(95Z.^ ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS /of.well/septic <br /> /) 7 cot!P( VC// AV <br /> (City,State,Zip) (City,State,Zip) , VI Setbacks <br /> AMI/` 0-1 I UI r sS---3 7/� <br /> PHONE PHONE _ �_ ❑ site Plan proval from <br /> L&3- j7,55---3— <br /> -3 ppli le township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> L,///,., )/1( /)754 t Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION '.;(http://accessdane. o danewi.usn Elevation of property PARENT PARCEL UMBER: CURRENT ZO ING 'ACREAGE: p P rty <br /> ❑ NUMBER C�l V 1071/- ' ro ye._ Jc'•- / .5.�'1� , (c 7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> DDRES J&Je-'���.� 1/4: .c '/.'/: S LA.; ❑ Drivew�rmits <br /> st county,town <br /> ADDRES . ( ry� <br /> '-'4/"fIt/ P c`--- 1`' ' ❑ Sanitary permits <br /> CSM: till LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: A <br /> c y\ \I ef1IIA dro p- iC 6 ,� , � a� -1 , <br /> , a <br /> ❑This project is a new building or cture. x -d. <br /> This project is an addition/alteration to an existing building or structure. ` ° ,,i -` <br /> SANITARY SERVICE: / PERMIT NUMBER: !.i4rt -- <br /> ❑SEWER ,JIEPTIC s i : <br /> HEIGHT IN FEET I NUMBER OF STORIES: (Not including basement) 4 - 7 <br /> ( I AREA TO NEAREST SQUARE FOOT: ®r ' 1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,..�`` <br /> BASEMENT 1 ST FLOOR: a ®t s 1: . " <br /> / TOTAL SQUARE FOOTAGE: EI-'ti,e"� ` V,,,,f <br /> J .- f <br /> 2ND FLOOR: 3RD FLOOR: ) (Cr n 1 - <br /> ( z -- :% o ,b' Z4 <br /> ESTIMATED CONSTRUCTION COST: 1/��(A�� � �`�� '� � <br /> -► -► —► -► -+ -► �d �J� , �� P� i=o ea1�§arc"= <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 .0 No ❑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? ..- DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0 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 ElNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 4 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -+ <br /> 545.112(4/09) <br />