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ez___F iq 1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> L _ � <br /> C�r �� i Zo <br /> Ening Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) s 3s9 3 Deed Restriction;CSM <br /> 7118 AL�o/t. ' .eo,.,4 M'L Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> -' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME �, <br /> 4iw4r Qd3.:_ 4.-14,1 --«.e.rre.-+ # S4,..0&--- L7Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7YL/ 14s J p/c.•+ *---P . <br /> (City,State,Zip) (City,State,Zip) L1f Se tccks <br /> 01L0O+a.ts.J WC S'3Sa L .4-0. <br /> PHONE PHONE Plan approval from <br /> (pot 43 ^ 19.° 4--• r .app• able township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> *104 44.5 K e 41144e-444-,, e.j- 4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ NUM ER 4708' /9v-OSLO/.fir 4/ ',5 1 frontage drawn to scale. <br /> TOWNSHIP: SECTION: `1` <br /> /1140 ONA "On/ l 1 1/: S`?- 1/41/: N� -riveway permits <br /> tate,county,town) <br /> ) <br /> 77/6' 4-4-.4 4.4- l/e�oNg w4 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> �-. 3l 5.4•.414 Awr g<r (public,private) <br /> PROPOSED PROJECT INFORMATION � r <br /> PROJECT DESCRIPTION: <br /> A <br /> . ❑This project is a new building or structure. f g <br /> 7 This project is an addition/alteration to an existing building or structure. : - <br /> �1 - <br /> SANITARY SERVICE: PERMIT NUMBER: `- ', t: 4 •° � <br /> ❑SEWER I�SEPTIC ; 9 , ^v --, xv', <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) � ',-1.-- c t 3 <br /> 241 ,rf /� , , <br /> AREA TO NEAREST SQUARE FOOT: : <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �= <br /> BASEMENT: 1ST FLOOR: ® $ `^t � <br /> 7.t. g3 L + TOTAL SQUARE FOOTAGE: j r 11 ;s.I",,11�v �� . <br /> 2ND FLOOR: 3RD FLOOR: r <br /> s ® 7 s '-",:;-L"-;::,' <br /> Zi9(O .�' /d J <br /> ESTIMATED CONSTRUCTION COST: / ,` s ,`P, „� <br /> (Please round to nearest dollar) ?J6'000 — ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0'N° ❑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? DYes allo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? O'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 Jo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes C2lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) –► ♦ –► <br /> 545-112(4/08) <br />