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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 /> .&-V <br /> II gmCa'I,Ca ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> -357 L ,i- S 2 E b R/ y am TDGE U o M W t 5353 Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> kr &3V/151 4408 331 .2V'9P bblicc;i IL C 0 Arai. Or <br /> _ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 6 c ❑ 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.tiane.wi.us/ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ <br /> NUMBER 051.1 -,29-1-...?ill-/ frontage drawn to scale. <br /> SE�TION�: W/%4 S S�//L.$ i SW R/1 <br /> ❑ iTOWNSHIP:hi-Bioi✓ Drveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Fi '2raN $i•c1+ (public,private) <br /> enie <br /> PROJECT DESCRIPTION: <br /> 5_11-EV i4'7-10/►` .vAi TA= <br /> CI This project is a new building or structure. ``',- . <br /> ,2 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: - �,, "! <br /> ❑SEWER ❑SEPTIC V a A* ,7 -'j':-,i' j. <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 /> �, TOTAL SQUARE FOOTAGE: 4 �� + ,-,77 1 � <br /> 2ND FLOOR: 3RD FLOOR: • � <br /> i s : s I16" e <br /> 4 3 ' §. <br /> ESTIMATED CONSTRUCTION COST: x� • ••, <br /> —► ♦ —► —► —► ♦ ' <br /> (Please round to nearest dollar) n °• <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? iYes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? XYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? , 'es ❑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 N'No ❑Don't know <br /> 7. Is this to correct a violation? 'Yes *lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />