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. ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> CO n e/I,' Ae/0/, 1,04"%=71 r'/,' a/Tali ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) i r/ <br /> Deed Restriction;CSM <br /> ,S"OP x2-? Pro e'e!br L.o /f'lf,ir-10,,// C✓/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6,a " 1 ° 861. ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C A,-/Ls. L',"/: ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> o? 7// 1F'rc X of//rom ff. . <br /> (City,State,Zip) (City,State,Zip) LI Setbacks <br /> tE/Z4 r G✓/ S--.?l// <br /> PHONE PHONE ` ❑ Site Plan approval from <br /> ,‘de-.- sc,- s-‘ 9 9 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> �, ❑ Floor plans to scale <br /> c��,-��s re i,//;47,/ Lo-��J✓.C.�yt� <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL /e-y / <br /> frontage drawn to scale. <br /> NUMBER �' //" /.2y o3,1 D <br /> TOWNSHIP: n SECTION:/ ❑ Driveway <br /> S t LX 1�4. J - 1/41/4: z,./ permits <br /> ADDRESS: 4- h x(7/1�,-/% / (state,county,town) <br /> CSM: LOT / SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> l (public,private) <br /> ‘.5"---c/ t�YOyoir G✓0!1"SI1t41o� <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: C -'7-717,-"1-''"air.;...„ <br /> a G///i !? /�.! 4) /e od a�� - -' <br /> ❑This project is a new building or structure. ` ®a., a � <br /> ❑This project is an addition/alteration to an existing building or structure. , , �� <br /> SANITARY SERVICE: PERMIT NUMBER: x ' I. r a c R : <br /> ❑SEWER V SEPTIC 3 a a ax <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '' ,� - <br /> AREA TO NEAREST SQUARE FOOT: ;"" , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , <br /> BASEMENT: 1ST FLOOR: <br /> ® , <br /> 4, TOTAL SQUARE FOOTAGE: 4, 3 0 a) ,*K <br /> c <br /> 2ND FLOOR: 3RD FLOOR: t °;*: <br /> yy � - <br /> a . <br /> ESTIMATED CONSTRUCTION COST _ r� a ti,pa .77--- <br /> (Please round to nearest dollar) "� "� $ (P7Q a 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ! No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes g'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? ares ❑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 L o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Micro- <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -0. -► <br /> 545-112(4/08) <br />