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ZONING <br /> • <br /> PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web•App#, <br /> PROPERTY,OWNER iINFORMATION ti'f . Y= ?.v "� ;;%-t. '4 : :`,-11:--'24. CUSTOMER TO PROVIDE <br /> OWNER NAME p / <br /> `-. —3 ` (� ( ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,S ate,Zip) S \ Q�A)� `-7 q Deed Restriction CSM�J� k� < 1 'S3 j 1 J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADORES <br /> ' i``- '2--73.`3% - S- I. - -535 9P ?;,J= ■ ' -( C. cz AA ❑ Site Plan drawn to scale <br /> AGENT INFORMATION - ,;' 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 /> LI Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION+::(http:l/accessdane.co dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCE NUMBER: CURRE TZONING: ACREAGE: P P rtY <br /> LI NUMBER O-SS (1- I-Vol-0 y 1 . I g frontage drawn to scale. <br /> TOWNSHIP: SECTION: o31S-t1 / <br /> ,))J R O \2_ N i s 0 ., , ,A: <br /> ❑ Driveway permits <br /> (state,county,tow <br /> n)ADDRss: <br /> 94x9 CQ )t— Q "� ❑ Sanitary <br /> anitary permits <br /> CSM: LOT 1 susDlvlsloN BLOCK/LOT it <br /> I • (public,private) <br /> C <br /> PROPOSED PROJECT INFORMATION, ,' ` - TA <br /> PROJECT DESC IPTION: ( - ,-7. �.,,y, <br /> 4 O � <br /> • ❑This project is a new building or structure. <br /> 9 �5� <br /> ❑This project is an addition/alteration to an existing building or structure. a ._, <br /> SANITARY SERVICE: m <br /> PERMIT NUMBER: ° , E <br /> ❑SEWER ❑SEPTIC ;$ 1 ; <br /> r <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) �-- 7 ,. - ,� -- <br /> �-- 59- '' E41 4 �� <br /> AREA TO NEAREST SQUARE FOOT: <br /> � � .- r 3 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , � <br /> BASEMENT: iS FLOOR: qv <br /> � <br /> 4, TOTAL SQUARE FOOTAGE: 4, i'a * � . <br /> 2ND FLOOR: </6 3RD FLOOR: , <br /> TIMATED CONSTRUCTION COST: -, �� i <br /> •-.:a,. .mac ® a m tti4g <br /> (Please round to nearest dollar) "* -► -4. "4. -+ $ '•.-,',�� -,/ # ' „ ,-Er ` ; ,-: <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes I1No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,gNo ❑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? gi 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 0 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ttiNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► —► -+ <br />