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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#: <br /> PROPERTY OWNER;:INFORMATION' ;;;- __ ' ? d way^,.,, ,.=,�- �t_a; w' CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> OWNER ADDRESS (Number,Street,Ci`,State,'Zip ❑ Zoning Status;CUP; <br /> / Deed 3 T �`a� Deed Restriction;CSM <br /> CCU Oeer �el0 kilt_ 5353 I Variance(# ) <br /> -OME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6 A -57 ,640 CS'1'77 In/ in A,/ e/'1 fh1-1 ('G,\ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION.;::, . 'i 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.wims/) ❑ Elevatif <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> P <br /> ❑ PARCEL fronts a drawn to scale. <br /> NUMBER 07Pd 3/-191/S-0-CS eti- I 34-c Z, g <br /> TOWNSHIP: SECTION: / <br /> /� 13 ,A: S 1 %: U ❑ Driveway permits <br /> COrif c�' (� aJP' state t <br /> ADDRESS: <br /> (state,county, ) <br /> i- <br /> • <br /> 743 Cd very Thm I! 141-4 63 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCIVLO (public,private) <br /> /0s3 g f <br /> PROPOSED PROJECT INFORMATION; T <br /> PROJECT DESCRIPTION: s, . :,,. s <br /> This project is a new building or structure. a <br /> ❑This project is an addition/alteration to an existing building or structure. , F - - <br /> = - <br /> SANITARY SERVICE: PERMIT NUMBER: 441A1 cl F ' ; <br /> ❑SEWER ❑SEPTIC 40 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) '" h ' <br /> ®} <br /> AREA TO NEAREST SQUARE FOOT: :: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) iTM t '� <br /> � a ®i° lA ® 4 BASEMENT: 1ST FLOOR: t <br /> 4, TOTAL SQUARE FOOTAGE: 4, r",-,,,-„.±:t-7.r.., f ] 1 <br /> 1 <br /> J <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ t ,(COQ , ,, =1�x. <br /> Please round to nearest dollar v '! <br /> ZSt 000 2O2 -T <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LYes ❑No ❑Don't know--------- - <br /> 2. Is there a wetland or floodplain on or near the property? lYes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? El Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 'RYes ❑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) fikYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes CkNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -+ <br /> 545-112(4/08) <br />