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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 /> ,5 f}L i'#I re 2C W- (,,ii !!4 CLc i/4 ❑ z CUP; <br /> OWNERADDRESS (Number,Street,City,State,Zip),, 54/46,k mar_ucyAA 1 eetela, lL + 3c, striction;CSM <br /> 1`,:,, f i,i , 1( • •;�• ._ .' _:.r_, ...!..L.....' r 4� Variance(# ) <br /> HOME PHONE CELL PHONE 'E-MAIL ADDRESS <br /> 77 3- Ye/-e VG - 773-yy7-34,34,/ 6.VL 6.4.c R I A &/ioz. e©ir/ WI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> :S. w E -C..4 `t c L. 1.C ❑ S 4 iqn including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of �e{{I))S''eptic ?ORLt( <br /> -P .6 Qax 1744 . <br /> (City,State,Zip) (City,State,Zip) La/Setbacks <br /> .Z•vtc.6 v r Ili 0T 7 5-3.5-Li <br /> PHONE PHONE ❑ I Ian approval from <br /> (e c - - -3 1 ap c ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ EI yin of property <br /> ❑ PARCEL O6/ _34'..4 0 eq-4` n jgx n 3 0. 0t?3 fro h a drawn to scale. <br /> NUMBER '] 17 J(- <br /> TOWNSHIP: SECTION: <br /> ILA/DV ,g6 1/4: 1/41/: ❑ eypermits <br /> ADDRESS: ( t ,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ S n ermits <br /> L c r 9 ( 6,private) <br /> PROPOSED PROJECT INFORMATION t <br /> PROJECT DESCRIPTION: - t ` <br /> .t_ENif ��NV \--VWSE. CI ZV.-%N COrnki b>,r✓E W rTN °,; 4 8�r <br /> ❑This project is a new building or structure. )7i,cS'lA€.'R. fLo° -i ' ', - <br /> iii: <br /> ❑This project is an addition/alteration to an existing building or structure. - �-.: <br /> e a us �SANITARY SERVICE: -I f I SEWER ❑SEPTIC a a <br /> . <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - ,�k .-' r '' <br /> ' i �� 4 I,l <br /> AREA TO NEAREST SQUARE FOOT: : .: 0 l• ri 1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) e <br /> BASEMENT: / 1ST FLOOR: b .� 1 r , <br /> A/✓ + TOTAL SQUARE FOOTAGE: ,, 1�® t � ��.r <br /> 2ND FLOOR: 3RD FLOOR: <br /> :...1 , '`5: a 1. <br /> ESTIMATED CONSTRUCTION COST: �'` «> _. , <br /> (Please round to nearest dollar) --► -∎ 1 S�� - r£ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? iiiiYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? BYes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes gNo <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 ❑Don't know <br /> 7. Is this to correct a violation? El Yes ,'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545-112(4/09) <br />