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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION` CUSTOMER TO PROVIDE <br /> OWNER NAME OF <br /> d ber-t C. L3'', 1 I ' °' f",s0^ ❑ Zoning Status;CUP; <br /> OWNER ADOR�ESSmber,Street City,State,Zip) Deed Restriction;CSM <br /> 1(11 IILL���� u Ni C&N ...9A-IJ S-0U°t .N kLE Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDR S <br /> beg—? 7 7—SSS 6e`S-'-f-4'-O"-S I-Cw',I I i 'Oe^-}>JrvVd Ia- w5CkJ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 3 A-ON &j..iiT 1` ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,zip) Ni A (City, te,Zip) ❑ Setbacks <br /> PHONE PHONE /� ❑ Site Plan approval from <br /> bt)'r ---- \-13—143c Lf applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT /P�ARCELrUMnBER: pCURRENTZ NG: ACREAGE: P P rty <br /> ❑ NUMBER LJ G. Q 6( I 3 I(9-G3 )-3 3 19 i30,/�j frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 0 b p(e -s a-.+ S Ct 15 S 1 1/4: NW 1/h: N V) ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> 314 1 )J PTO Ro -D 3$C)U ��'0 ❑ Sanitary permits <br /> CSM: LOT SUBDI ION BLOCK/L0 <br /> Ci <br /> `) (public,private) <br /> PROPOSED PROJECT INFORMATION . a <br /> PROJECT DESCRIPTION: <br /> • ❑This project is a new building or structure. ,-,--t.,-,...,�,_ - <br /> *Ii <br /> This project is an addition/alteration to an existing building or structure. ,, „ <br /> SANITARY SER : PERMIT NUMBER: °° = � <br /> EWER ❑SEPTIC t ,q -., , , <br /> ., a � <br /> HEIGHT IN FEET: � NUMBER OF STORIES: (Not incl •'ng basement) �� 1�':: � �� �a, -� <br /> s * �3- - r a. g . <br /> AREA TO NEAREST SQUARE FOOT: - E <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 2 <br /> BASEMENT: 1ST FLOOR: ^' <br /> V 3g- 4, TOTAL SQUARE FOOTAGE: 4. 0 4 a! a ,s, <br /> 2ND FLOOR: ,G 3RD FLOOR: 3- - E <br /> s , s� <br /> ESTIMATED CONSTRUCTION COST: o �" , : W,$ <br /> (Please round to nearest dollar) . + "'r -0 -+ °.: w <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes tEks10 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes to <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) LI Yes .No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />