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,-zi? .r,......1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web.App# <br /> PROPERTY OWNER'INFORMATION ;;'r , _ r21 ' ii 0, . ;i :===,',27--..--"- f 1 ';-t- <br /> CUSTOMER TO PROVIDE <br /> OW R NAME �/ <br /> ��1 U _ pr �' ❑ Zoning Status;CUP; <br /> O A DRESS (Numbe/rr,Street,City, tate,Zip) Deed Restriction;CSM <br /> 3�/z/ 1 D�f� h12 iSS {!? tc2r 5 35 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> , . €! 614-7Z - Ct Sav. S' Q 1 '. ❑ Site Plan drawn to scale <br /> AGENT INFORMATION -;: CONTRACTOR,:INFORMATION` x and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> s'a"t^e /1--- / e/(-- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) LI Setbacks <br /> PHONE PHONE LI Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION .;(http:l/accessdane.co.dane.wi.usn; ❑ Elevatif <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> P <br /> V NUMBER 0-3[94,701? -303 fg1/p 4 -/ V frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> �ij/�� Jp� /: ❑ Driveway permits <br /> ADDRESS:`��'— r n s� 1/��' `��, (state,county,town) <br /> 3.S/`/ Tim l it l Q ef/ljjS /'�G G 'S'"35 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DE RIPTION: II h a <br /> ,� G i4CCeSSee-i/ II1I ®hl ,.1 :a,. <br /> -tom <br /> • ❑This project is a new building or structure. o � � <br /> This project is an addition/alteration to an existing building or structure. �` sa i <br /> SANITARY SERVICE: PERMIT NUMBER: _ . 'a;`{•' ,- <br /> iSEPTIC r J -� -`lam,. <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 16 " / ��� p �a .l� 'F+ d <br /> AREA TO NEAREST SQUARE FOOT: = $- `:` <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �. e ®����� ® �� �� <br /> 4, TOTAL SQUARE FOOTAGE: 4, ._s ,�t , <br /> 2ND FLOOR: 3RD FLOOR: <br /> ',V.A.'- <br /> .f .r",-",� "'� <br /> 74 :mow = < wI <br /> ESTIMATED CONSTRUCTION COST g®i t <br /> (Please round to nearest dollar) '♦ ♦ --► "♦ "♦ $ 2�©� �, : '' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Elm— ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L f <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 T—❑Don't know <br /> 7. Is this to correct a violation? ❑Yes El-New <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />