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r <br /> ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web-App#. <br /> PROPERTY OWNER i:INFORMATION .Y '.,;'. ;4;400 , c,?.= `,• CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> .r; v AK. ..C,a,;04(16- <br /> OWNER ADDRE S (Number Street,City,State,Zip) ❑ Zoning Status;CUP; <br /> � T Deed Restriction;CSM <br /> �( 37 B.lI.ZfE,n� (dC/k''> ,C/�f�..s�` 4JL S35"3� Variance(# ) <br /> HOME H E CELL PHONE E-MAIL ADDRESS <br /> I, -;af", - a ��;-...5-75--- 255- Stir - .r 6" i' red/, •CaM ❑ Site Plan drawn to scale <br /> AGENT INFORMATION. ' CONTRACTOR INFORMATION :` and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION:INFORMATION.;(http://accessdane.co dane.wi.usn; •CURRENT ❑ Elevation of <br /> PARENT PARCEL NUMBER: ENT ZONING: ACREAGE: property <br /> ❑ NUMBER 7/00 C.)..&7b 0 6 ,(7/,4 /5-0 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> W��'6Sa/ 1/4: 1/41/,; ❑ Driveway permits <br /> ADDRESS: / (state,county,town) <br /> 76 3 7 ( Z � 64/4> ❑ Sanitary permits <br /> CSM: LOT 7 SUBDIVISION BLOCK/LOT (public,private) <br /> J <br /> PROPOSED PROJECT INFORMATION, - r�,,,,TA <br /> x <br /> PROJECT DESCRIPTION: G,� t : <br /> G,d�a.&, i S� d 10 I ti I T-) -- i.4zr�:k ' <br /> [Ilia This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: lrel rIkAlt:746 ° : <br /> ff�� ; �, <br /> ❑SEWER ❑SEPTIC ��� - ; �v � � � � <br /> HEIGHT IN FEET f NUMBER OF STORIES: (Not including basement) ,.- <br /> AREA TO NEAREST SQUARE FOOT: V <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �1E �' " � � <br /> BASEMENT: 1ST FLOOR: <br /> b d e ® r �, <br /> /.e) (71, 4, TOTAL SQUARE FOOTAGE: 4, ��- ,# )° ,�c V <br /> 7 • 7),'f`ro eT lam V ,- <br /> 2ND FLOOR: 3RD FLOOR: <br /> V w <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please dollar) -► -4. --► -I. -4. -1 . :C 4 e s e Oe,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 Ett o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ii Yes rieNo ED Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? L►�Yes ❑�No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes El/No <br /> 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 ■o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes (Xio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► -► <br /> 545-112(4/08) <br />