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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION �s? _ °4 ` d;emu M �; _::- . t CUSTOMER TO PROVIDE, <br /> OWNER NAIL <br /> `lo tJ d 1M 2pa90v/p-iQ`7 SF <br /> N N Zoning Status;CUP; Zrob J <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM �_7 <br /> 6 Z�� Putt cc-CL (L D Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> kOS•VII •o81/ [Site Plan drawn to scale <br /> AGENT INFORMATION : CONTRACTOR;INFORMATION,. , and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS - CONTRAC DRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE Site Plan pproval from <br /> appli a township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.coaane.wi.usl) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: r Elevation of property <br /> ❑ PARCEL O q - 0r p r /� Z g frontage drawn to scale. <br /> NUMBER S n l b�'OW � �9•3 <br /> TOWNSHIP: SECTION: <br /> Q���� C -/. �/ -/,/.n ,Driveway rmits <br /> ADDRESS: (state, Unty,town) <br /> S th OA k'' Sanitary rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public rivate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: n ��; s <br /> K€S Pr sal 102f/C - $` }; <br /> This project is a new building or structure. '" � ` 3 <br /> C3 This project is an addition/alteration to an existing building or structure. -, <br /> SANITARY SERVICE: ` 3 � c.91, tre"t4 s i,�� <br /> ❑SEWER L -EPTIC , If � a ° : i'" ',''-''''.-',t-', <br /> , <br /> HEIGHT IN FEET NUMBER OF Ti-IES: (Not including basement) � - a �--�� <br /> AREA TO NEAREST SQUARE FOOT: 7� ® . ,s- °ff ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) : -? g, <br /> ( 9 9 9 9 P ) �„o <br /> BASEMENT: 1ST FLS OR: <br /> r.� <br /> a 0, ®� e� ® . <br /> ' a /63 j TOTAL SQUARE FOOTAGE j ' „ �I _ , �-�_ <br /> 2ND FLOOR: 3RD FLOOR: CJ� f r <br /> I' fl. /D �t„ r . a a n ` * —? <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ � i e - �r e t 6 . ,. <br /> (Please round to nearest dollar) $ �. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Cl Yes cif No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tig 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? 52 Yes ❑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? LI Yes ty1No <br /> APPLICATION(Continue on Back MUS)T BE-i SIGNED-► -► <br /> 545-112(4/O8) <br />