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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /0/WV.4 SARa, I? ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> /lita- ILES • /!. /Q./(> . (fEll24 JA (AJ/ X35-93 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / <br /> gy •/3 g.S&- S 5'eS' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> wl0_k. Eh4 _ NO! LI(Y (,Q evSTDrr, ilon.yg ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> n • 9 <br /> &c--nu -+ro.v PikA Aitivi <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Ar,LSOn/i r.1.1/. S37// <br /> PHONE PHONE ❑ Site Plan approval from <br /> 60 - a/el—8 78`..? �e-- A 7C,/._pcc/a applicable township. <br /> E-MAIL-ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER '7171>3-3-(aG_3-t-U A- 1 <br /> TOWNSHIP: SECTION: <br /> .+ 100.11-Sal/ ' ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3s-s-- 4 k CEO A Li ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION i777;-71 1 - , <br /> PROJECT DESCRIPTION: ,`rte }} ��:�` <br /> ,,14 This project is a new building or structure. ;;;..---,,',.. <br /> . , <br /> - <br /> ❑This project is an addition/alteration to an existing building or structure. ',s -,, ,, �� � ���� <br /> SANITARY SERVICE: aid 4 <br /> ❑SEWER SEPTIC � 4 "a' ':,..i € max^ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) " � ': <br /> v ® , <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: s a � <br /> A,S—©S y3 q ,l TOTAL SQUARE FOOTAGE: ,, � . ' I Y,1� T <br /> 1 c� T ^h ? <br /> 2ND FLOOR: 3RD FLOOR: < <br /> r 61 `7 ©2' : ' ; 4 <br /> ESTIMATED CONSTRUCTION COST: �', <br /> -∎ � --. ♦ -i -. 6o7� 0(�, <br /> (Please round to nearest dollar) $ DD �; , �� 7,�. �. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 4No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes C83 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 4 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 5:1No <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 I, Don't know <br /> 7. Is this to correct a violation? ❑Yes A No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />