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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 /> ej1YL6 i. Lin 44.. Schenk ❑ Zoning Sta ;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed triction;CSM <br /> 14144 VO5en Ed. Middle-4,m WI 5356.2. ari ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> rat,"3e 11 4144-307 1 G SC-j'1 k orWS.f-r dr Si a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> i Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> (City,State,Zip) (City,State,Zip) S tbacks <br /> PHONE PHONE Site Plan approval from <br /> a licable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Fl or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CU�jRENTZO NG: ACREAGE q Elevation of property <br /> rty <br /> D PARCEL O w ~0 ^9 I /NUM ER ^ I p?, o <br /> frontage drawn to scale. <br /> TOWNSHIP: SECT <br /> het i ddt0-on — 1/<: N Q %%: ' ❑ Driveway s <br /> ADDRESS: 1 (St OUnty,tOWn) <br /> 14?4/� " ©�SQ n ❑ Sanitary per•.' <br /> CSM: • \ - LOT SUBDIVISION BLOCK/LOT <br /> [) (public vate) <br /> PROPOSED PROJECT INFORMATION } <br /> PROJECT DESCRIPTION: �� , <br /> Aaa -}ion -I-o s ck-ro�� i fry} <br /> . ❑This project is a new building or structure. 4 � y <br /> 1 ,This project is an addition/alteration to an existing building or structure. _ <br /> SANITARY SERVICE: PERMIT NUMBER: �Wt 1 1 ' .� <br /> ❑SEWER EPTIC : - f, ` <br /> HEIGHT IN FEET 1(� NUMBER OF STORIES: (Not including basement) r � <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ¢' i 0 <br /> BASEMENT: 1ST FLOOR: ( g :1, TOTAL SQUARE FOOTAGE: , " <br /> 2ND FLOOR: 3RD FLOOR: ✓ 7 y , <br /> ESTIMATED CONSTRUCTION COST: --► �M .- Bd 01:4-4.5,-. 0-51 <br /> Please round to nearest dollar) / � : ,,s ; � _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? SYes )Vo CI 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? EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes , o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan 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 16,No <br /> APPLICATION MUST BE SIGNED <br /> 11 (Continue on Back) —► —► -* <br /> 545-112(4108) <br />