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i 1,1 s 4 <br /> i <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME. <br /> IV R7 LA . I'Y) A HF Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip <br /> /2V9 61,/,17- ?©4t eed Restriction;CSM <br /> Variance(# ) <br /> F(pME PHONE CELL PHONE E-MAIL ADDRESS <br /> $35-•d 3'3 e 57 .2.95-2 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Scr _ Ste..,,,-.C...__ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) j4 Setbacks <br /> PHONE PHONE Site approval from <br /> appl' able township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevtif <br /> PARENT PARCEL NUMBER: CURRENT 2 NING Elevation of <br /> : ACREAGE: <br /> ❑ PARCEL qq ! frontage drawn to scale. <br /> NUMBER 7S d (`j Yj+-� E r — -l�tj <br /> TOWNSHIP: SECTION: <br /> C)t'-2 ' %: N '/%: LJ Drivewa ermits <br /> (state ounty,town) <br /> ADDRESS: f� (� <br /> 114 L) <br /> VI Ci/ ' L " Sanitary •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publi ,private) <br /> C. <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: , `''�? - --"` N r <br /> . xi This project is a new building or structure. r , h : .. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: � "s , ,,r <br /> ❑SEWER •EPTIC V ,, ,-. iate;~ ' ' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) -, ', * ' <br /> Es 1-. ashy Ei'-- 7 F _s.. <br /> py <br /> AREA TO NEAREST SQUARE FOOT: 7A -. 2 -, <br /> .' ! , i <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � '�' <br /> m a � P <br /> BASEMENT: 1ST FLOOR: . <br /> 1\ / + TOTAL SQUARE FOOTAGE: ,, 5 . „-`., I„.,.,{��f:;�` <br /> Q C7 `-a ^� s ,'''712ND FLOOR: 3RD FLOOR: <br /> V `-...' ii -_I � -4 �! <br /> ESTIMATED CONSTRUCTION COST: / ,5 ; , .:i <br /> (Please round to nearest dollar) --► -* "'P. $ - ^,_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 14 No Cl Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4 No LI 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? pYes ❑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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes cu No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />