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• <br /> -ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER;:INFORMATION J,;;; .,_,zz ;; !3". .' ,,,,. - ..r .,_ �, ' `? CUSTOMER TO PROVIDE <br /> OWNER NAME Q J <br /> • <br /> G"j4 R Y 0 ) fl C7 1 1V ❑ Zoning Status;CUP; '` / <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> / 0 1 L S/h X/7 /CP Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> / �, L/ <br /> C0�_ Li -s7 - 3/47 fY <br /> tx <br /> Site Plan drawn to scale i[ is 1 <br /> AGENT INFORMATION .. CONTRACTOR:INFORMATION,-,- „ ; and includes dimensions / -- `' <br /> AGENT NAME CONTRACTOR NAME <br /> %'= • atrnii(ig location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic...) <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks C3/30/,5-0 0//3 <br /> PHONE PHONE OM Site Plan approval frorr, <br /> applicable township: /F/ 14 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION '.;(http://accessdane.co dane.wi.us/);!; <br /> PARENT P MBE�j RENT I ACREAGE: / It-20 <br /> of property <br /> ❑ <br /> NUMBER <br /> 22- + ) '3 . ) (. frontage drawn to scale. <br /> TOWNSHIP. I SECTION: i�t A v` Z /SE //. rV ei Driveway permit / v <br /> /a' <br /> ADDRESS: / (state,^ / f � (state,county, T <br /> `II „ 1r / (A � <br /> csM: ,,. ?as.— LOT SUBDIVISION BLOCK/LOT h Sanitary permits 6 k <br /> `/ (public,private) /1-"A <br /> PROPOSED PROJECT INFORMATION: G� <br /> PRO DESCRIPTI r r � �, ". <br /> L ✓ IA•/ / I� `_ D fo( c1 / _� <br /> r � t ��; s <br /> This project is a ne�...,..1,.r:n=-�... ure. : <br /> This projec • an addition/alteration . an existing building or structure. e <br /> ( ' C <br /> SANITARY SERVICE: ��_ PERMIT NUMBER: ' ` <br /> � 1 <br /> ❑SEWER SEPTIC 8 } a t <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not incl ding basement) ' <br /> ,: I E AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) N '- l <br /> BASEMENT: 1ST FLOOR: /� 0 m�®! it'ag � �. 0 i <br /> // (,/ 4, TOTAL SQUARE FOOTAGE: 4, s +1- �` .- . F t <br /> X15 ° � , -- <br /> 2ND FLOOR: 3RD FLOOR: //7 6 <br /> ESTIMATED CONSTRUCTION COST: --► --► -3► --I. --► —i• <br /> n� ��t pp <br /> Please round to nearest dollar C/ <br /> 1. The property is within 300 feet o a stream or 1000 fe:t from a pond or lake? urYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on • - - property? LI Yes ONo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement?..., CI Yes allo <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# ) ,,((l eave blank if none) <br /> 6. Is a location survey required? (see reverse) 11'iJ Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? Yes ❑No <br /> 1 L3 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) .+ —► —► <br />