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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO • - - DE <br /> OWNER NAME , •/i �,, <br /> (/1 J 1,dil4 QM/$'62 UU/h,► •r Lt 4 V Y K Zoning Statu.;CUP; <br /> OWNER ADDRESS (Number,Street,City,State Zip) <br /> 9607 teak $,Q/�'tR �lecIR .c Y S t 3 Cs3 Deed Restric • ^." <br /> r( 2 Variance(# • ) <br /> HOME PHONE CELL PHONE / E-MAIL ADDRESS <br /> 608 -S •- 172 6 c- 2 f 3 Ai Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> t�l ea r 6u 11.44.n/ COY'''. / Site Plan including locati <br /> AGENT ADDRESS CONTRACTORAODRESS .f well/septic <br /> (City,State,Zip) (City,State,Zip) ASetbacks 90/....--0/ D(4� <br /> PHONE PHONE eromol� V f '3gi3 kite Plan approval from <br /> 60g y g 00 \applicable township.A/ D�0 t <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 2 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) r!i Elevation of property <br /> PARENT PAR�r,EI NUM CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL ' '/ D —i 95i0 r.j/r7 a rontage drawn to scale. <br /> NUMBER / /lJ °- <br /> TOWNSHIP: SEC ;l 3 ` <br /> r <br /> 4— <br /> /v t $Q✓' /� / /4: 1/41/4: /�� Driveway permits <br /> ADDRESS: state,county,town) <br /> 726 '✓Y,', ( e 0mQt '1 Sanitary permits J <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: . •: _ <br /> fi <br /> . ❑This project is a new building or structure. v 2 - <br /> This project is an addition/alteration to an existing building or structure. !:-.---. . <br /> 1 r� <br /> SANITARY SERVICE: �� PERMIT NUMBER: : 'a .. �-� :� <br /> ❑SEW SEPTIC r, �� i� a 4� - z S <br /> HEIGHT IN FEET: // NUMBER OF STORIES: (Not including basement) <br /> / & m <br /> AREA TO NEAREST SQUARE FOOT: , � - , 0 � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` , �. <br /> BASEMENT: 1ST FLOOR: p 8,- if`® ";`,4 <br /> 0 4, TOTAL SQUARE FOOTAGE: . 1 , � ;3), ,. d1., i <br /> 2ND FLOOR: 3RD FLOOR <br /> a 1 <br /> ----- 100 8 �� - Y � .s <br /> ESTIMATED CONSTRUCTION COST g , ,4� <br /> (Please round to nearest dollar) —O. Z-�� 00 sP � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes fNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 Baas? ❑Yes igNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal --9 ' ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) CI Yes Flo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes , No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545.112(4/08) <br />