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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAM <br /> nv'' Pt-e c,K.. ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /3 5-7 vkht eve, 8�/ep n-e. w= 3'3 5-4e variance(#_ J <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 601—'4 7�5-5-58 c j oN_V..tak Q ye..I-s pa earn <br /> El Site Plan drawn to scale <br /> AGENT INFORMATION I 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/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER aYlt/s411—III-869!_0 a/ /( P)'a' /9 9// frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> FlESS: (Fri YeS 1/4: 1/4,/4. ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> a1/71 Qtfrin Sri re/ 5Ystitjtviis "IX 5-3 5-t9 ❑Sanitary permits <br /> CSM: LOT SUBDMSION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION F T F ..l-1 i'. <br /> PROJECT DESCRIPTION: . - ' <br /> . ❑Thls project is a new building or structure. gFfiq4,lt ,rit ait-fi :. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: [014-.010 V-,°°ia' ' <br /> FIEWER E)EPTIC ` wa ! ), <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> O <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside(Outside dimensions including unfinished area,attached garages and above grade decks or porches)BASEMENT 1ST FLOOR: <br /> 0 'o, 4, TOTAL SQUARE FOOTAGE: O `;S •e [61 _1a r <br /> 2ND FLOOR: 3RD FLOOR: . - <br /> te �0 - <br /> ESTIMATED CONSTRUCTION COST O v . •!.i - <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ '♦ 7O • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes 12iNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes NNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®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 No ElDon't know <br /> 7. Is this to correct a violation? DYes jNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />