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• <br /> �7� , <br /> sfs,_ <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT_to Web-App# <br /> PROPERTY OWNER INFORMATION ...z=_;_: _1,;' .. M1. .„; ._:<, , ,, "- CUSTOMER TO PROVIDE <br /> O ER NAME <br /> AA) e-� v ci 4 �`-a de Zoning Status;CUP; <br /> OWNER ADDRESS u er,Street,City,State,Zip) Deed Restriction;CSM <br /> t �0 7 0 AO .uV e ,� i2 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADORES <br /> 8315 ‘ q 7 3 5-- 9 co N 0. A) c r ` / 4.14-r225 ,co Site Site Plan drawn to scale <br /> AGENT INFORMATION . CONTRACTOR:INFORMATION ,: l and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S C--( ✓A 5 Cc OA- Q 0= Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (city,state,Zip) (City,scare,Zip) ►9 Setbacks <br /> PHONE PHONE �� Sit- -n <br /> • I•'-bletownshipapproval :from <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 401 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co4ane.wj.us1) ! 0 Elevation of <br /> PARENT PARCEL NUMBER: CURB TZONING: ACREAGE: property <br /> P rtY <br /> 0 NUMBER o 381 a7of-o5J- 9331 4, / 4/ 7. 9 ontage drawn to scale. <br /> TOWNSHIP: J 4-r.) SECTION: <br /> 1.1 G) d 1 >V ,A. %,�<. Driveway pe <br /> ADDRESS: p '/n� (state,coU ty,town) <br /> 7& N 0 N') e,2. IA 6 P an'F% ,permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p •• ' , •.rivate) <br /> / <br /> 1555 <br /> PROJECT DESC-IPTION: <br /> • his project is a new building or structure. `� ,.. �+ <br /> s�I���ate �'�r �- <br /> ❑This project is an addition/alteration to an existing building or structure. Al. max , s <br /> SANITARY SERVICE: PERMIT� (NUM:SR: <br /> 1,„. P �.. . <br /> ❑SEWER SEPTIC 1J V CO <br /> �'A.° ' 1 <br /> HEIGHT IN FEET: /, NUMBER OF STORIES: (Not including basement) <br /> — 9 114_1/ / s s i 1 �r :6 @q-s r" I <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t ' V iitieir4di BASEMENT: 1ST FLOOR: <br /> 3 o as 4, TOTAL SQUARE FOOTAGE: sl� x <br /> 2ND FLOOR: 3RD FLOOR: $,� --' y-OO 6 <br /> ESTIMATED CONSTRUCTION COST: x <br /> / ® •89c ' <br /> (Please round to nearest dollar) '�•■ ♦ '♦ ♦ "'■ "♦ $ S•�° K 3 � � :°� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? gYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? .�Y.es ❑No jlirOsuil.t.kgiaw <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 ;i4 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? LI Yes ❑No <br /> ALIATUS BE <br /> (Continue PP C on ION BacMk)T -i E -►SIGN E.+D <br /> 545.112(4/08) <br />