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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OVyiER NAME ,e <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State ip) Deed Restriction;CSM <br /> I/157 (/r,(0.) 02 a� an 1105 CY l Variance Restriction; ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60 aa -Yet7? ‘oY( C)4-50/. <br /> ❑ 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 6/9/c 91 j— 0654"o4d� 9 A-_/ c-_C • yob V frontage drawn to scale. <br /> NUMBER d <br /> TOWNSHIP: SECTION. <br /> To Cu et c'f 6 He Group O Co ' : .5 LE. %I/y: /ff!:t) ❑ Driveway permits <br /> ADDRESS: ` (state,county,town) <br /> yam- U.`4�,5 Ai <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> Q J(J�i'l Do.h/ He'thh (public,private) <br /> PROPOSED PROJECT INFORMATION _ <br /> PROJECT DESCRIPTION: <br /> P‘,1-1-'.--) Dec K 0h QAc/ d Is 61°',S—P. , �' S4 <br /> ❑This project is a new building or structure. f` <br /> §This project is an addition/alteration to an existing building or structure. „z <br /> SANITARY SERVICE: PERMIT NUMBER: e a c , <br /> ❑SEWER =41 SEPTIC a l° i : <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ':"s, i , � � <br /> AREA TO NEAREST SQUARE FOOT: .,." 1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � "'� ° <br /> 2 ,0 . <br /> BASEMENT: 1ST FLOOR: E` <br /> 4, TOTAL SQUARE FOOTAGE: ' - <br /> - 1 six lx ,,� <br /> 2ND FLOOR: 3RD FLOOR: <br /> ado 57/ /' <br /> ESTIMATED CONSTRUCTION COST: ad__ = <br /> ♦ ♦ ♦ ♦ ♦ ♦ 0 s gaak <br /> (Please round to nearest dollar) $ ��d ��, a , --,::-w; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes jklo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo 'Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? nYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes , -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 ,KNo ❑Don't know <br /> 7. Is this to correct a violation? <br /> ❑Yes Pil-No <br /> D. ; 7c =23 <br /> J�) <br /> $U APPLICATION MUST BE SIGNED <br /> 545-112(4/08) r (Continue on Back)p <br /> —0. ♦ ♦ <br />