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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> °ir, hr-e`Di /4 Zoning Status;CUP; A e_.l <br /> OWNER ADDRESS (Number,Street City,State,Zip) ''A Deed Restriction;CSM / J / <br /> �S`l/I /9 firer'ire re-ce J. Yt far'-t l✓/ ,5-359'3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> $12- (07(0 It '24 (05"of k Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME / CONTRACTOR NAME <br /> A"�Q� '�a9 46,,,` `"e:0 0 H P-1 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> S7G [-:�.,�. ° "- <br /> 1 Setbacks C3/36/6 3 is' <br /> (City,State,Zip) (City,State,Zip) / <br /> Svn Prot rl e_ hl/ S357d �:� Site Plan approval S <br /> PHONE PHONE pproval rom d/,4 <br /> i 941_ g77 3 applicable township. ��/ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 'wtiA" • ar- .e0Y12.1 Eta/. Lor, OA Floor plans to scale ./7 // <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> /3// y <br /> PARENT P E KE 9e/D CURRENTIING: ACREAGE❑ PARCEL r�0,,, /t 3 �µ —� 3 ?3,II frontage drawn to scale.NUMBER Il��h v / I 7 q If <br /> TOWNSHIP: SECTION: u ' <br /> Ski 1 , S ,v OA Driveway permits <br /> SP, ,;�g �1� z� /4: r4r4: (state,county ar W/ <br /> ADDRESS: <br /> 5,zi11ArL0 rir c �- <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits 0 4_Z I (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> " <br /> PROJECT DESCRIPTION: , �p - a <br /> ®This project is a new building or structure. Mp , � <br /> CI This project is an addition/alteration to an existing building or structure. - ,e <br /> SANITARY SERVICE: PERMIT NUMBER: I. 'fit 11"t' �3` <br /> ❑SEWER � EPTIC � ' �` '�, � ��� F��� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ��� <br /> / " <br /> AREA TO NEAREST SQUARE FOOT: -- , mom ' : A l <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a s pp <br /> BASEMENT: 1ST FLOOR: . n : <br /> TOTAL SQUARE FOOTAGE: J - it � t,: <br /> �y r,ill r -' .,a <br /> 2ND FLOOR: 3RD FLOOR: ` <br /> ESTIMATED CONSTRUCTION COST: i �g,® /� <br /> (Please round to nearest dollar) /2� OD � , -,,,-, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes ®No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No LI 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) LI Yes ANo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />