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• <br /> In <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> o R NAME I n <br /> he s- I (._. V V� e—I ❑ Zoning Status;CUP; <br /> o, NERADDRE$S mber Street,City,StateRd .) Deed Restriction;CSM <br /> .0318 r r4a/L be FDre_S- 0/ 5353. Variance(# ) <br /> ,H ME PHONE C PHO• E E-MAIL AD P RESS X 4 )4 v. i.-# S/ 'S S 3O p"5531 . -4.1e - Q / ■ c eX ej e, 0 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dir nsions <br /> AGENT NAME CONTRACTOR NAME ``''��D <br /> U r•' i'rl!~I[l'ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • well/septic Q-. \/(City,State,Zip) (City,State,Zip) ❑ SSeI Clss 3 200$ <br /> PHONE PHONE ❑ Site YPlan approval fl1�t <br /> aup Q. . n�^�'tw'' <br /> E-MAIL ADDRESS E-MAIL ADDRESS q1 1pj�,,�� �P <br /> Q' ►�door plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONI G: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL ' � 0 —C�3/,Y.�?_9 A- ] q frontage drawn to scale. <br /> NUMBER O <br /> TOWNSHIP: SECTION: <br /> 3u r k 3 -1/4: NE. wh: IN ii ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 6.- i Po;-1-a Qc <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> „,r1cc_ /ass' ,.{- )yam (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> p 7 t <br /> PROJEC ESC IPTION: ,, ,. <br /> � <br /> Qce <br /> eMCIosed bock-- ptrc t ,, <br /> ❑ his prbject is a new building or structure. rz o'-' <br /> d � y <br /> This project is an addition/alteration to an existing building or structure. , � � <br /> SANITARY SERVICE: PERMIT NUM Al x°° 1. ,. <br /> ,—,� V7 ' e s , <br /> ❑SEWER Cr'EPTIC �� _ 44,-,i),- <br /> HEIGHT IN FEET: �-. NUMBER OF STO IES: (Not including basement) �� <br /> AREA TO NEAREST SQUARE FOOT: _ <br /> (Outside dimensions including unfinished area,attached •arages and above grade decks or porches) ` ` r� , °_ <br /> BASEMENT 1STFL•• i ® a�9 <br /> (it, 4, TOTAL SQUARE FOOTAGE: } at 1 " a <br /> 2ND FLOOR: 3RD FLOOR: , ,7 t ® o a. t ,' <br /> !V Now(..c�, <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ,� 111r-414-Z.:::;1,f441:1144-1 <br /> (Please round to nearest dollar) $ � f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes` 21-No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes gNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? LWYes 0 N <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ig/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 Iilo <br /> APPLICATION MUST BE SIGNED <br /> 545.112(4/013) (Continue on Back) ■ -► <br />