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. , <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> a,/R )cr,P 'y 'TA ZPL C` t ❑ Zoning Status;CUP; <br /> OWNEERRADDI ESS ( mber,Street,City,S te,Zip) / / 44 �,/ tCr Deed Restriction;CSM <br /> HOME PHONE ) �'I CELL PHONE , 'E-MAIL ADDRESS <br /> 7e 6 2 Variance(# ) <br /> '% 0/ G ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> e i Cr4 Sc",,e�c� 9�h 5 4c,e,7.e/ 01 n 4,yp ii.Q Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS -- of well/septic <br /> "12- 377- ��v ( 3v 5_,,,,/e1/...„7 . <br /> (city,State,ziP) (City,State,Zip) ❑ Setbacks <br /> Gone eo c 4- w 5"35`S6 PHONE PHONE ❑ Site Plan approval from <br /> 66 5-,T'3 .2 --2— applicable township. <br /> E-MAIL ADDRE 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 /> ❑ NUMBER 0 7 0 q NO Li Iv • i frontage drawn to scale. <br /> TOWNSHIP: SECTI : <br /> �/.:/ / .,e f /C /: „--..6., WA: CI Driveway <br /> ADDRESS: <br /> (state,county,town) <br /> CSM: -, 33 LOT SUBDIVISION t `�� ' ` ❑BLOCK/ OT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION z <br /> PROJECT DESCRIPTION: , <br /> / 1= : . �2 <br /> p-This project is a new building or structure. � � � � � <br /> � <br /> ❑This project is an addition/alteration to an existing building or structure. a _ g - ' : <br /> SANITARY SERVICE: PERMIT NUMBER: '�14 :' , ���� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) `' � , -, -' - <br /> 1 /0 ' 4b � / , <br /> AREA TO NEAREST SQUARE FOOT: 4 ,. <br /> (Outside dimensions including unfinished area,attached garages a • ;bove grade decks or porches) ,'. <br /> BASEMENT: 1ST FLOOR: ;: <br /> ___ ,_ ,, TOTAL SQUARE FOOTAGE: j e ,i i a � <br /> 2ND FLOOR: 3RD FLOP. <br /> co?' S i ‘' - QE's <br /> � <br /> ESTIMATED CONSTRUCTION COST: r7 " 4 : � <br /> Please round to nearest dollar —• --► —i• ♦ - ' <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 allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? El Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes A 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 411-No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes l'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />