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•4 i <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION; . _;" `. '; �,,,:�;. ._.� w CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1�1�1,1'Ite L 6 A1 lei--- <br /> 0 Zoning Status;CUP; <br /> OWNER AD RESS (Number,Street City,State,Zip) <br /> )� '. n Deed Restriction;CSM <br /> Ed's,-7_Se° ��%e� ,�-� "`�' Variance(# ) <br /> HOME PHONE / ,CELL PHONE E-MAIL ADDRESS a e/. .ecAsi <br /> S'j 3r�l0 S 2 11 te Iv! \ <br /> ('(,�,mo-c)S1?UP,�'t�-feted'(/" ' • rLrSite Plan drawn to - le <br /> AGENT INFORMATION CONTRACTOR::INFORMATION i'ii,...";:,;1:‘ and includes di ensio s <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRA OR ADDRESS o el septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site pproval from <br /> appl'eab township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> E Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION .(http://accessdane.co,dane.wi.usn 1Elevation of property <br /> PARENT PARCEL N MBER: CURRENT ZONING:ibp ACREAGE: p P rty <br /> ❑ PARCEL OS'Zro 5/v _J Q2-k130-0 4.1 Co.oor frontage drawn to scale. <br /> NUMBER r J "'l 1 V ( <br /> TOWNSHI ; SECTION: <br /> o la e/ /01' 19 ,1/44: /n W 1/4�4: 4 w ❑ Driveway permits <br /> ADDRESS' �` (state,county,town) <br /> 1.00t2 low /1 M <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 11105 - Z N <br /> PROPOSED PROJECT INFORMATION '', "�` E ,, <br /> PROJECT DESCRIPTION: n 5 ��l,, 4 1^ , ehis project is a new building or structure. -4�i ,, -, a <br /> ❑This project is an addition/alteration to an existing building or structure. �'- � " <br /> SANITARY SERVICE: PER U BER: °o <br /> '110'- ❑SEWER EPTIC �� t�� F-� <br /> HEIGHT IN FEET: Z n , 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) i, `s ` � 3 <br /> BASE ENT: / 1ST FLOOR: �� <br /> S� JJ 1 4, TOTAL SQUARE FOOTAGE: 1, ,t ,.- <br /> w <br /> 2ND FLOOR: 3RD FLOOR: ., 1•d 0 702 �,: i', ? �. <br /> ESTIMATED CONSTRUCTION COST: ; ,M:1.4 <br /> (Please round to nearest dollar) "i '♦ ♦ --► -+ $ �5/OU0 <br /> 3 rta-2r f QI feitac4S <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ' ❑Yes ■ lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'Flo ❑Don't know <br /> <3.1-lave you talked with the township about your project and are they in agreement? llZYes ❑No <br /> 14.Has there been a zoning permit issued for this property in the past 5 years? &ties ❑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 UI l(o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />