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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# t <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME _// <br /> ,i-'S,14 / l rh PA Zoning Status;CUP; q/9(Si' <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM / <br /> /6- 9/ ofe,-(z A. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 5 16 -52 r;' %LIB <br /> ' Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAM CONTRt CTOR NAME <br /> I Sdn) <br /> loddi ,N , (,) y/ <br /> 0),A.' (,Q1(,c to(s C l XSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 12Y( rC okl „ Or' • <br /> (City,State,Zip) (City,State,Zip) P Setbacks <br /> v7 41 1/ W I 5- 3 S-67 <br /> PHONE 66 U PHONE `,� Site Plan approval from /�/ <br /> GUu"' C>6 R— /5-S/ ` applicable township: + ►► <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .4— I i Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn r�� Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> ❑ PARCEL 404 y b o b I)3 a3.,It 1Z -1 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP:/f/p - SEC d , r• -1/4-1/4: �d Driveway permit 0 1):i‘. <br /> Y LL+ ,A P( , 'A1 S I: <br /> ADDRESS: / (state,county, . cP L <br /> 3062 6,c 5k_ i2-L,i 1r(• :1 S. ' -rypermits N �CSM: LOT SUBDIVISION BLOCK/LOT <br /> 7 2 lv ,„t G0 �S�wr, 'ubl ,private) <br /> PROPOSED PROJECT INFORMATION P <br /> PROJECT DESCRIPTION: / /t �/�� °d <br /> ' 1 4 CM— L (0)( (L) C, j/� V—11�I T.7rl ts�l f as 37,t {.'- /�• <br /> • it This project is ne , ilding or structure. k li ,P (J <br /> ❑This project is an addition/alteration to an existing building or structure. : 1 Y.- ;, . <br /> SANITARY SERVICE: PERMIT NUMBER: 0 _ �l. <br /> E SEWER ❑SEPTIC A. 0 I L/ . ' r t....114* <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �� '„ <br /> ,J @': I <br /> AREA TO NEAREST SQUARE FOOT: . r 7 , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ��°r <br /> BASEMENT: � 1ST FjlJ Y � ® � <br /> � � - + TOTAL SQUARE FOOTAGE: 1 ,;,, 7 i aY q-w ` A, <br /> 2ND FLOOR: 3RD FLOOR: f � <br /> �_- <br /> ESTIMATED CONSTRUCTION COST: —► -► � � y$$900 6 , 0 0 �� �A . . , <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a ond or IaKe? laYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ,I 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? 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? ❑Yes 2 N <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />