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. ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web-App# <br /> PROPERTY OWNER;:INFORMATION 4:1'.:,: :: lZ_ X4 0t.a; .,: ,,_' f,:;_'' :;., CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> e/6 4"/J 4/�,j) ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> -7d 6-6, /1/, Gi/,qf "t0 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 3 7 -y-5 8. ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION !Y .. and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> / i <?WCS /Ze- EA /e/t.[te,f° CiLs Tem /1, 4.,l ,,t ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 71-" 4.1 /`iVy'A/ „Cr. 7/5"l✓, eW0,n. S/ , <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> s' ,v #4 ,,,///@/,C' 4/r fss7(. ----3 --C74,--)7,1- <br /> PHONE PHONE ❑ Site Plan approval from <br /> 46-3 .?— 6 d 7 6 s,-,... 4_ applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> LI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATIONi:;(http:7/accessdane.co dane.wi.us/) ? ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑ NUM ER Q q Pi rJ'd/f e frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> tl.e/S 'U.i._ i✓[ /: iv %lk ❑ Driveway permits <br /> (state,coup <br /> ADDRESS: ( county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 2 ) (public,private) <br /> PROPOSED PROJECT INFORMATION; <br /> PROJECT DESCRIPTION: 1"1' % -- u Z <br /> 4/111/ '4� --- .Z;/r�-e n- � 'i -. <br /> ._ <br /> la his project is a new building or structure. l S ,r : <br /> ❑This project is an addition/alteration to an existing building or structure. i <br /> SANITARY SERVICE: PERMIT NUMBER: r® <br /> X 4.. 4„ J ^" <br /> ❑SEWER ❑SEPTIC - � ",, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ` , ' <br /> A✓/ i J <br /> i-ijiqairkril i 4;n-` '-1q-4 Wy k. ' <br /> AREA TO NEAREST SQUARE FOOT „ Y <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' �'' <br /> BASEMENT: 1ST FLOOR: e ®O•V - <br /> TOTAL SQUARE FOOTAGE: ll-�i ' " <br /> 2ND FLOOR: 3RD FLOOR: f <br /> j : <br /> n 0 eo° e e; §y � <br /> ESTIMATED CONSTRUCTION COST: . e 1 g� <br /> (Please round to nearest dollar -► '9 -0 -0 -► <br /> /MI 's <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ....ii7. ❑Yes L )o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? !V/J ❑Yes L ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? .... ❑Yes L! 'No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ago <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 ( )o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes LiNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -+. <br /> 545.112(4/08) <br />