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• <br /> ' ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> & R ArthrSiOA ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 6 �7RrES4vriz[1 4et 3v., P ,'-,'(. w/ S'3S D Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 7 " St/6 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> ,/AGENT NAME / CONTRACTOR NAME <br /> DM/tfCw44 AA.(PO e By/i4CY3 /1 I i LI Site Plan including location <br /> AGENT ADDRESS /J CONTRACTOR ADDRESS of well/septic <br /> S 1/ile1tari.N' Le- ivn . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> %lvs". Pry.,:-,e till S359 <br /> PHONE PHONE ❑ Site Plan approval from <br /> q qq-5773 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> LI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: LI Elevation of property <br /> PARCEL O9,/,leg•zz79.7 <br /> NUMBER A_/ D. 7oc/ frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Sri 6to) .29 1/4: A./i4) 1/1/4: NW ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 6$35 till lbv/rt i4 .- . /1‘ Pot,;-,•e. !I!/ .'3 S9D <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION 1 BLOCK/LOT <br /> 29 rtif 42- (public,private) <br /> ��z w <br /> PROPOSED PROJECT INFORMATION 77-7:X .; <br /> PROJECT DESCRIPTIO • t� � �,��_ • � �� _- : �' <br /> 2 i ,.� s <br /> . is This project is a new building or structure. ` 11fi <br /> ❑This project is an addition/alteration to an existing building or structure. :, � <br /> SANITARY SERVICE: PERMIT NUMBER: > i. •° � <br /> ❑SEWER ❑SEPTIC ; 'p a 't <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) •�� <br /> I f1 ktt apt ) i°'„ ,7-'-t?`� <br /> 11.9 - � Y�L � � 4 3 <br /> AREA TO NEAREST SQUARE FOOT: � - �� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> N/ zG�O +, TOTAL SQUARE FOOTAGE: j �, a ����' <br /> it':ATtrrio-17-W4, r <br /> 2ND FLOOR: /ft 3RD FL 0� <br /> .4 �: <br /> ESTIMATED CONSTRUCTION COST: �_ ': �'- -i, :a <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? ❑Yes &No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Ll No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? El 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) LI Yes ®No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes l ,No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i - <br /> 545.112(4/08) <br />