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ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION;:,; •' .,14 `.4 -w ^,"C • .,r,=:' r <br /> OWNER E CUSTOMER TO PROVIDE <br /> 7thieln£C 4 ,.,57•'OA/ <br /> ❑ Zoning Stat , P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ! r • ����� Deed riction;X70/ GUST ,raj. �/ des riction•CSM <br /> ante(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> a 3'770 `351_ ile Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTORINFORMATION ° and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> G dfI ?/7606 - ■ /L/) Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS . . �-��� of well/septic <br /> (///2G�Y6f-/ ( s 3' <br /> (City,State,Zip) (City,State,Zip) 9/Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicebl>s township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ or plans to scale <br /> PROPERTY/LOCATION'INFORMATION" (http:l/accessdane.co.dane.wi.usl) r-y <br /> PARENT PARCEL NUMBER: j Q CURREN ZONING: 4 ■ ACREAGE: .Elevation of p erty <br /> ❑ nPiuMBER © b© '? ^ (3 1 ^A,\Z f Y li-/ A ' frontage dr n to sc Ie. <br /> TOWNSHIP: SECTION: N E- N U� <br /> ADDRESS: <br /> /3 1/: 4) 1/%: ❑ (stvew ounty, own) <br /> X70/ ‘as% /e7J • <br /> CSM:9 / da L,•T SUBDIVISION BLOCK/LOT Sanit p mltS <br /> (pub) ivate) <br /> PROPOSED PROJECT INFORMATION -' _ V'JEW E <br /> PROJECT D CRIPTION: <br /> G S"To. t. /3 limed a 8i) Ca ?< S 0 . ,i,� 034 r. <br /> ...aThis project is a new building or structure. x � <br /> ❑This project is an addition/ Iteration to an existing building or structure. = ,- <br /> SANITARY SERVICE: t/Q/t PERMIT NUMBER: i r� <br /> e �N <br /> ❑SEWER SEPTIC I � a <br /> HEIGHT IN FEET: (k( NUMBER OF STORIES: (Not including basement) <br /> °. ' 068 t4P` 1°�'. <br /> AREA TO NEAREST SQUARE FOOT: :,". <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) g ', -Z ` . <br /> BASEMENT: 1ST FLOOR: t ._ ° - <br /> (t 's`,1 ©� 4, TOTAL SQUARE FOOTAGE: 4. , pi� ? q <br /> 2ND FLOOR: 3RD FLOOR: ^�, © � � <br /> ESTIMATED CONSTRUCTION COST: <br /> l <br /> -► ♦ -► -► -► —► / .� ..r—,--AA., <br /> (Please round to nearest dollar) I 0 0 - <br /> / <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 21io ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? .0 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes -ErNo <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 .21vo ❑Don't know <br /> 7. Is this to correct a violation? DYes ,„.12No <br /> SAPPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) ( ) <br />