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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NA E CUSTOMER TO PROVIDE <br /> ME LEA CR4 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ Zoning Stat UP; <br /> r'1 • f' Deed riction;CSM <br /> // <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS /ad Ce(# ) <br /> Gab' • --',8 , _ ' 'c to ' 13 <br /> A <br /> GENT INFORMATION CONTRACTOR INFORMATION ite Plan drawn to scale <br /> AGENT NAME CONTRACTOR NAME(SAME o nd includes dimensions <br /> AGENTADDRESS E As .4�- J S'a Plan including location <br /> CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) <br /> 7 (City,State,Zip) Setbacks <br /> PHONE <br /> PHONE ❑ ite PI approval from <br /> E-MAILADDRESS p' able township. <br /> E-MAIL ADDRESS <br /> lour plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> of PARENT PARCEL NUMBER: CURRERONIN REAGE: Elevation of property <br /> PARCEL €11) r i '� <br /> NUMBER dN .) . • ,� • '� frontage drawn scale. <br /> TOWNSHIP: SECTIO 1 ` <br /> �� ' GRavg /4: /J El 1/1/: ❑ Drivew permits <br /> ADDRESS: (stat county,town) <br /> 509 N. f4rR 04Ks 4vii , ,2 wz. �'37/y <br /> CSM: LOT t <br /> (� SUBDIVI t,N /_ :LO OT Q ❑ Sanita , .ermits <br /> e-i t ( . bq tit . c 1 k < (p b ,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: v o <br /> 1� <br /> • ❑This project is a new building or structure. F <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: t ��T <br /> PERMIT NUMBER' �`: , ' <br /> %SEWER ❑SEPTIC -' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) a, -' `> .- � <br /> 3 <br /> AREA TO NEAREST SQUARE FOOT: ;47 2 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' � � <br /> BASEMENT: 1 ST FLOOR: � <br /> - �a .W-4-,;i% <br /> 7� ,, TOTAL SQUARE FOOTAGE: 4, J 1°s .",r <br /> 2ND FLOOR: 3RD FLOOR: <br /> 72 , - :,-: <br /> ESTIMATED CONSTRUCTION COST <br /> (Please round to nearest dollar) ♦ "► --► ♦ ♦ —► $ 400 <br /> , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes �l�,,tt <br /> 2. Is there a wetland or floodplain on or near the property? ❑ yallo ❑Don't know <br /> Yes VrNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? <br /> Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes XNo <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) <br /> ❑Yes ❑No Don't know <br /> 7. Is this to correct a violation? <br /> ❑Yes )(No <br /> r- I <br /> APPLICATION MUST BE SIGNED <br /> 545112(4/08) . <br /> (Continue on Back) BE <br />