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.06:c - oc,,G& <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAMg,- <br /> '..--__if- Meisii' ❑ Zoning Status;CUP; <br /> OWNERADDNumber,Street,City,State,Zip) / Deed Restriction;CSM <br /> R(/ (/ ( gl y �,v y U . di(,�v L4 . 53Sr3 Variance(# ) <br /> HOME PHONE CEL PH NE E-MAIL ADDRESS/ <br /> i/ ,q :- _'18" / - - Gt,. ' , , , . • ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL C,, 2 /j `�,, // r frontage drawn to scale. <br /> NUMBER a// 997;3a-930-e) /e/1 -� J <br /> TOWNSHIP: SECTION: <br /> )t/i/y _ c,73 1h: 4/(�) %%: ,5 (� ❑ Driveway perm its <br /> filf// I (state,county,town) <br /> ADDDRE <br /> a // ,/ <br /> �dV r;vie/y - y ' Sauk y ❑ Sanitary permits <br /> cSM: LO SUBDIVISION N l BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT D C 91PTION: 11' <br /> G / L°� i <br /> i.� t <br /> . This project is a new building or structure. � � 7 , _ <br /> ❑This project is an addition/alteration to an existing building or structure. . fir., <br /> SANITARY SERVICE: PERMIT NUMBER: •t" ' --��i <br /> ❑SEWER ❑SEPTIC --' -t'''".;=''" -- - 4 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) te , ; , , <br /> � ee ,, q ll :::n7 <br /> 1aa® .�' '. 3V <br /> AREA TO NEAREST SQUARE FOOT: ? ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,,'Y , '` <br /> BASEMENT: 1ST FLOOR: ® <br /> m <br /> , <br /> TOTAL SQUARE FOOTAGE: , <br /> ` <br /> e s <br /> 2ND FLOOR: 3RD FLOOR: , <br /> Y , -f <br /> R,q ,• a its <br /> ESTIMATED CONSTRUCTION COST: a , <br /> (Please round to nearest dollar) ♦ ♦ "� ♦ "♦ - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes in No ❑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? ❑Yes ®No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? El 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 t 'No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes f No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />