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• <br /> ' 'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN AME //��, <br /> C/A.(' /al,n4 e,-r t vo-c ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> Po &5X "5L> t1 d,f0 el -5 7/3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> e2 L/ti—"73/ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO TRACTOR NAME <br /> 5G4 iii I `l`ei/ in e_, bv(/4,e/5'„ 4 C ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ,pm *G01- .acib2 . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> wok- .:l..2,0• S'f i) applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: Q SECTIO <br /> l v1/4.014 O^Co p. vN <br /> 7 ,/a: 5.4v ,/1/: 5_14/ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> L/q S 14 D t" `r 1� 't, rc t I ❑ Sanitary permits <br /> CSM: LOT SUBDNISION BLOCK/LOT <br /> Ct Pni I i s e.-1/4L (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> , 11s , <br /> 5 -;:,67.f).;.-- 711111i),:7, <br /> � _ n PROJECT DESCRIPTION: <br /> 4.6 x' 4 519011/ti t 1 q/ i't9`oe ,p- <br /> . X This project is a new bulling or structure. , <br /> 0 This project is an addition/alteration to an existing building or structure. Ei <br /> SANITARY SERVICE: PERMIT NUMBER: *i4, 4 - <br /> ' a zC - <br /> ❑SEWER ❑SEPTIC ' „ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 'x r a <br /> 5 s,- a i r ? <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �` <br /> BASEMENT: is O R: s _ <br /> 66,0 S: 4, TOTAL SQUARE FOOTAGE: 4, �3 �� <br /> 2ND FLOOR: 3RD FLOOR: Jam` q 6 a,>n� <br /> ���� a ;_. � <br /> ESTIMATED CONSTRUCTION COST: <br /> 1grk/ DD o �--� ��°� <br /> (Please round to nearest dollar) - _, -�► -p - r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gi 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? NYes ❑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) ❑Yes 0 N EI Don't know <br /> 7. Is this to correct a violation? ❑Yes %No <br /> RO 'D•\ cc Do-✓ 01.6 ( APPLICATION MUST BE SIGNED <br /> 545-112(aloe) 'Z. (Continue on Back) ♦ -► -4. <br /> s .., 40..,,,,,i;:i z ,/oo <br />