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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> oWNE•NAME CUSTOMER TO PROVIDE <br /> ri i <br /> rrl Ic [oning Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) <br /> ay7? �,tnv, DI 11^t t't'1011 W,T S3 Se9 Deed Restriction;CSM <br /> HOME PH NE CELL PHONE , E-MAIL ADDRESS <br /> Variance(# ) <br /> Gag.7/7-5-S5g 'ell_ aec ke - ' ' ' ' YrSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location w al'. <br /> AGENT ADDRESS CONT'• TO• :'DRESS of ell/septic - -� il <br /> (City,State,Zip) (City,State,Zip) <br /> Q`Se N£Eb 5:6-Ts <br /> tback� ps <br /> PHONE PHONE <br /> Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> [']Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (hltp.//accessdane.co.dane.wi.us/) <br /> OPARENT PARCEL NUMBER: CURRE9 ZONING: ACREAGE: levation of property <br /> PARCEL <br /> NUMBER Q4j��77���G9/-0 G— /o` 41 ] , G frontage drawn to scale. <br /> TO` IP: SECTION: <br /> U re��.�` S P 11 S ® 411,4- •Driveway permits <br /> ADDR 5-s: —7 �t (state,coup town <br /> T I /Q n n 11 SUBDIVISION N Sanitary permits <br /> CSM: LOT O BLOCK/LOT , <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DEC RIPTION: S £ ` <br /> IS• This project is a new building or structure. � _ . - <br /> OThis project is an addition/alteration to an existing building or structure. `max V i <br /> SANITARY SERVICE: : `.€ 7 <br /> PERMIT NUMBER: ti .• -.. T'6i ��s; <br /> -u <br /> fib( ) -ao I —003°)3 <br /> EWER EPTIC � �`� Re�IV"�k-'i I�" h t,�.�' Y. <br /> HEIGHT IN FEE: f NUMBER OF STORIES: (Not including basement) ',UV ` g' r z <br /> San dr atta Ment) <br /> AREA TO NEAREST SQUARE FOOT: m- M <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , <br /> BASEMENT: 1ST LOOR: ,_4 • loan oiIuoip�erm ., , <br /> C I TOTAL SQUARE FOOTAGE: I ,(s • sturSan e BTU/,6" <br /> 2ND FLOOR: 3RD FLOOR: 1 47": : 0 E <br /> ESTIMATED CONSTRUCTION COST: 0i -�uey C <br /> 1. and avalable vp or� <br /> (Please round to nearest dollar) /� ,_ <br /> ow. 1. The property is within 300 feet of a stream <br /> or 1000 feet from a pond or lake? QYes �lo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes ONo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes ONo <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) QYes ONo ODon't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUS BE SIGNED <br /> 545-712(4/08) (Continue on Back)T = = = <br />