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• ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME t_ <br /> a{h 1 '� r ❑ Zoning Stat ,CUP; <br /> OWNER ADDRESS (Number,Street,City, tate,Zip <br /> L Deed riction;CSM <br /> 2c CC �� I e�v�c'S+ L \ .� ar' ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (oC�j x`16-H�Z <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE AME CONTRACTOR NNAME Q ,r <br /> V L(� s r Otsun p ro1A fr'S 8,..„ 5 e Plan• uding location <br /> AGENT ADDRESS CONTRACTO�RP DDRESS f w ept:c <br /> 4�'y U ( nvt� ���� �? Icy tootles Uc�1 6 ' <br /> (City,,ttate,zip) (ci e,zip) Setbacks ili, <br /> PHONE PHONE 6 ❑ e Plan royal from\000t-34 I <br /> 2 7G/_ 7ro C� —5 �(� p lic a township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ADDRESS (',,,,(2-r(f - 1-)f f �b�a� �jC etrr4 /, ✓►2 loot plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpN/accessdane,_r_1ane.wi.us� Elevation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONING CREAGE: P P rtY <br /> PARCEL o6 9 � ` 3 frontage drawn to sc <br /> NUMBER 8/0 9 1 D-32Z-Z78Y�-1 — <br /> TOWNSHIP:II••� II (.11 SECTI N: ` , Permits <br /> lv I i1 S(?f '/a: �. %/a: N IfV Drive <br /> ADDRESS: <br /> (s e,county,town) <br /> co - 2. L, p-o f Sanitary mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pub' ,private) <br /> PROPOSED PROJECT INFORMATION a° .} <br /> PROJECT DESCRIPTION: <br /> /� �Q1'tlUi-1 4�1� � MOIjL(_i G� X �� �� �i <br /> . ❑This project is a new building or structure. �` <br /> his proje is an addition/alteration to an existing building or structure. r <br /> SANITARYSERVI E: <br /> PERMIT NUMBER ���� <br /> SEWER ❑SEPTIC <br /> Ps ''. <br /> HEIGHT IN FEET: 4:9 / NUMBER OF STORIES: (Not including basement) = <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> t.` ,,,(,�i'.! F`3 C,p <br /> BASEMENT: 1ST FLOOR: AJGJ ;�0_ Lj I <br /> D l TOTAL SQUARE FOOTAGE: y , . ; y <br /> tA)!in-) � X2.1 ` P <br /> 2ND FLOOR: O 3RD FLOOR: 4%1 jg A <br /> to L1/ <br /> ESTIMATED CONSTRUCTION COST: .,:, .kl ,r ,it 1. �� <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ "� 1 t3 C� , ,? <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes V o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es No Don't know <br /> 3. Have you talked with the township about your project and are they in agreeent? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 yea <br /> rs?m Dyes �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? ['Yes J21‘1° <br /> APPLICAN MUST BE SIGNED <br /> (Continue TIO on Back) —► —► —► <br /> 545-112(4/08) <br />