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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER`.:1NFORMAT,ION° ;: .. z ' ;?. - ::'�; ..�._ < <;:1_ .- CUSTOMER TO PROVIDE <br /> OWNER NAME r /2:-74-11/1 /fir ( i5 `2 ❑ Zoning Status;CUP; <br /> OWNER ADDR S (Number,Street,City,State,Z ) <br /> /7e) /-71/ �l C- � z.4� 3-35-3 z/ Deed Restriction;CSM <br /> / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 03-/ /4 3-3s--- 6.s_s ° .314A LA�' V taw, '1/4) 1.- ❑ Site Plan drawn to scale <br /> AGENT INFORMATION .:' CONTRACTOR;;INFORMATION' Y` and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> . -:=3/1 �UZ,C �Y\ 4--1"011, 6vi/dims ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /Y0°h/PAS--7 Ad /-"ii )0' hly / 6 • <br /> (City,St,ate,Zip) z 1 , (City,State,Zip) CI Setbacks <br /> J a v5 d tz i Lc 555-f .4, lf\ <-t t-L--_/- 5)0.3 <br /> PHONE PHONE - _ CI Site Plan approval from <br /> 7317/-c 12 _26/- 1/ / applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION .:(http://accessdane.co.dane.wi.us/) , ❑ Elevation o <br /> Elevatif <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> P dY <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER (Z-27y- ./'2,'e) -�C-- 2- /` i//r <br /> TOWNSHIP: SECTION: <br /> 4/XicA■ .,7_-7 1/4. 1/1/4: ❑ Driveway permits <br /> ADDRESS: , (state,county,town) <br /> /711 //71 s/ '� / ❑ Sanitary permits <br /> CSM: LOT SUB. :ON BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION; _ <br /> PROJECT DESCRIPTION: , _ ' � 4 * ') <br /> ...- �� � ate" <br /> S _ _ i <br /> V� 5z-f x t 7th ! 1 Pg `r <br /> This project is a new building or structure. , <br /> ❑This project is an addition/alteration to an existing building or structure. x : '''.7 — � <br /> SANITARY SERVICE: PERMIT NUMBER: OP p a o '1 t <br /> ❑SEWER ❑SEPTIC,��t V" e � , <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) , ` # <br /> " ® -rte S S.�FyT ffd <br /> AREA TO NEAREST SQUARE FOOT: -max <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) . <br /> e p ®fi n - TES <br /> BASEMENT' 1ST FLOOR: �'? <br /> ..� 4, TOTAL SQUARE FOOTAGE: 4, g. 9 0a1 3, ,,,--, <br /> 2ND FLOOR: 3RD FLOOR: <br /> el (So Cil <br /> ESTIMATED CONSTRUCTION COST: `� � <br /> ® � - <br /> (Please round to nearest dollar) '� "� 2gt©4,Cc�^� ./ 4- n <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 4 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ei 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? LYes ❑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 ZNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />