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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER i.INFORMATION ,;;; : __ '3. ; ;1i, ,r: _._:- t., :, "`r CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /FoQS/e 7 RiQtiZ-k ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 6,035 9 IL Deed Restriction;CSM <br /> 307"Vi 6/900 61706 6.. 4cti,yo,2 sr v .veicA-'7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 708-77 -18 S71ov/X kiCIO' ,7/.2a R, ):9//0 v - c o,ti LI Site Plan drawn to scale <br /> AGENT INFORMATION,r,:: CONTRACTOR INFORMATION ' ' and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> • <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 ❑ Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P ro e <br /> P dY <br /> ® PARCEL frontage drawn to scale. <br /> NUMBER o0�2 losia-asy^,za�3'd /z 3 ♦ 33 <br /> TOWNSHIP: SECTION: ❑ Driveway <br /> Tow,c) . of 19L 5/o�cJ ,r, 5 '/<: S.F %1/4: Al. L(/ permits <br /> ADDRESS: (state,county,town) <br /> • <br /> 3 7 i/9lkE s/'°'CE Pie, ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> " Pbre7D ) terti H PAR/ .2 <br /> PROPOSED PROJECT INFORMATION, - _ ,if,, ,. , { T <br /> PROJECT DESCRIPTION: . � / a <br /> ❑This project is a new building or structure. 'f Eli ; ,. <br /> ❑This project is an addition/alteration to an existing building or structure. : :, ',„ <br /> pi ' 9 i�` '-SANITARY SERVICE: PERMIT NUMBER: „� Q <br /> ❑SEWER ❑SEPTIC � a ��.�a � � = — <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) t �x �- <br /> ?LI Or4.;40,0X6.14.9qt AREA TO NEAREST SQUARE FOOT: ®- � .';i1,. .:' <br /> � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 5 ' <br /> BASEMENT: 1ST FLOOR: 6 �� � ` <br /> 4, TOTAL SQUARE FOOTAGE: 4, ;:&,`- <br /> . ' as ` .' <br /> 2ND FLOOR: 3RD FLOOR: : � - <br /> ESTIMATED CONSTRUCTION COST: m g®t <br /> (Please round to nearest dollar) ♦ "� '♦ "� "♦ $ o7O, 000 r fi x <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <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# ) (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? LI Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —. —► <br /> 545-112(4/08) <br />