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• ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER N E CUSTOMER TO PROVIDE <br /> L TOO )1/4,/ <br /> OWNER ADDRESS (Number,Street,City,State, ip)L �1 0- Zoning Status;CUP; <br /> '3 o (1414- I [� 12t -��� `�`� Deed Restriction; CSM <br /> HOME PHONE L PHONE E-MAIL ADDRESS /Variance(# ) <br /> 0 /Xf6 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ^^ CONTRACTOR NAME <br /> 61np � ? t5 11:4 (- • d <br /> Site Plan including location DD ESS <br /> � CONTRALTO' ADDRESS <br /> 120 6 t i t ISou &f / Z gA of well/septic <br /> (City,State,Zip)W (City,State,Zip) <br /> Setbacks <br /> PH NE PHONE <br /> (0(9811614.- (� Site Plan approval from <br /> _ i0-0 applicable township. <br /> E-MAIL ADDRESS i E-MAILADDRESS al <br /> Floor.0 v sit U0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.chane.wi.us/) 4A r <br /> PARENT PARCEL NUMBER: CURRE _ ONING: ACREAGE Elevation of property <br /> ❑ PARCEL <br /> NUMBER %O O C� <br /> "Ii y - 41 1 - I Q frontage drawn to scale. <br /> (� <br /> TOWNSHIP: SECTION: <br /> �IUluc1 LV '/4: '/4'/4: ❑ (sta y permits <br /> ADD SS. /1 (stat county,town) <br /> 96 ?2 f�� L . 0 S permits <br /> CSM: LOT SU DIVIS ON BLOCK/LOT <br /> • f AAA (Pdbii rivate) <br /> PROPOSED PROJECT INFORMATION ;. <br /> PROJECT DESCRIPTION: "~ 't.151,07:1:17 3 A-r-fi ,4 a dam, 4 ,� <br /> • ❑This project is a new building or structure. <br /> :igi41.66101)RW <br /> is project is an addition/alteration to an existing building or structure. :, <br /> X <br /> SANITARY SERVICE: ,�� PERMIT NUMBER: t'd ' e <br /> ❑SEWER .t�J SEPTIC <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) :',FA:tiffqfhtiiqijrri*V,c; <br /> AREA TO NEAREST SQUARE FOOT: 411 `°" <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> 2S'z Z 5-2_ 4, TOTAL SQUARE FOOTAGE: 4, �' e ,f, :4� <br /> 2ND FLOOR: + �'= <br /> 3RD FLOOR: �a <br /> o o <br /> ESTIMATED CONSTRUCTION COST: "∎ - "► $ G 5-2...00 <br /> ° ' W t(Please round to nearest dollar) i , , <br /> r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EKo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes Lilo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ®110 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le ve blank if none) <br /> 6. Is a location survey required? (see reverse) 4Yes ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —► —► <br />