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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 /> I/a rt../ € S t D 6A. 5 era p Las i J 13,C ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,�Sttrteet,City,State,Zip) Deed Restriction;CSM <br /> HOME PHONE a /CELL PHONE � 7 E-MAIL ADDRESS <br /> e v I l W k 6 375 /{ Variance(# ) <br /> b08L( 2' 2. , 3 LD e r • O-as'c, el,td Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> rie1t �>` ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> t k i id 83 e (-4 ar-rR � bJ- . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 1-,bt W , 3c , <br /> PHONE PHONE ❑ Site Plan approval from <br /> (o Q - 5 76 - q 7 7 t applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCAT:ON INFORMATION (http://accessdane.co.ciane.wi.usa <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL / .3 ,y y (�s <br /> NUMBER frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> �� J '/a: '/.'/.: ❑ Driveway permits <br /> ADDRE ` �SD r (state,county,town) <br /> 6 e IE. , ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ,„ -, <br /> PROJECT DESCRIPTION: �- =,'-`' -. . <br /> czk._e t.,iLD C - 7-0 R- — A e Q i -3_,.m:, <br /> ❑This project is a new building or structure. ,{ <br /> • ,This project is an addition/alteration to an existing building or structure. �4 <br /> ��� <br /> SANITARY SERVI E: PERMIT NUMBER: °° <br /> SEWER ❑SEPTIC ,a '& �a ' " -= t,-2' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> :: a® Is . �. , - <br /> AREA TO NEAREST SQUARE FOOT: a -x� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` },r P <br /> Ai v: ® �'d d P 4k <br /> "� <br /> BASEMENT: 1ST FLOOR: 1 TOTAL SQUARE FOOTAGE: ,l. e I t? . , <br /> 2ND FLOOR: 3RD FLOOR: ! ® -� ; ° <br /> ESTIMATED CONSTRUCTION COST: � , a i • _,�a iY� . - <br /> (Please round to nearest dollar) "■ "� /� (��� �; - ,„ ,,z,..,,,,„,- <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 1.4 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? E/Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 12 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? Yes ElNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -► <br /> 545-112(4/08) <br />