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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME • bite`, <br /> P / ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,Ci ,State, ) 'yaw c a em <br /> 30 i eZ 1 'I 1 A� 1213. ` r, � e3L Deed Restriction;CSM <br /> .7 �/ L. Fi 7 7� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NIE CONTRACTOR NAME /! /I <br /> I�C.N SpreehQ,� 5PR C11 e. evgop4 1Tt. ❑ Site Plan including location <br /> AGENT ADDR SS CONTRACTOR ADDRESS of well/septic <br /> 1S9( Loaf IAA) RS 7991 vititer 0,iLJh'4O <br /> (City, te,Zip) (City,Ste ,Zip) ❑ Setbacks <br /> U /014 / 5'397 t/e ,4- Gil/ 53,93 <br /> PHONE � PHONE 40,4 ❑ Site Plan approval from <br /> 575 5[e $/3 9 f7S-8(35 applicable township. <br /> E-MAIL ADDRESS E- .ILADDRESS <br /> SPQxt 1412 27Z 5• "T S '2ELKEi2erzl•/er❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAG ' ❑ Elevation of property <br /> ❑ PARCEL ��'I .o b 1-?see_ frontage drawn to scale. <br /> NUMBER V `v7 / �� t� • ��aZ <br /> TOWNSHIP: SECTION: <br /> PL <br /> Qti, W '4 k)&' (r 1/4: NE. 1/41/. ❑ Driveway permits <br /> (state,county,town) <br /> n)ADDRES <br /> D103 v I LA-9 lP A- CA8' agouti lit 535.V ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOC Or (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTIO . . s -.-,,,,%,-," <br /> ❑This project is a new building or structure. -� i = . �� <br /> , V This project is an addition/alteration to an existing building or structure. n, <br /> SANITARY SERVICE: PERMIT NUMBER: 421'If-MI s w b <br /> ❑SEWER SEPTIC ' � - 93r a , <br /> gh it � <br /> • HEIGHT IN FEET: 19, NUMBER OF STORIES: (Not including basement) = .' ,- <br /> AREA TO NEAREST SQUARE FOOT: ter" ' � � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , <br /> BASEMENT: 1ST FLOOR: 1'. a .� x� <br /> ,, TOTAL SQUARE FOOTAGE: 4, = a f,, �j,.i + <br /> 2ND FLOOR: 3RD FLOOR: —700 4 i • <br /> ESTIMATED CONSTRUCTION COST: <br /> ♦ _, -* - 8 s b e 4th af <br /> (Please round to nearest dollar) 3�/ ��� �_ • p.. ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes i/No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? L"Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Flo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LIYes ❑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 0 Don't know <br /> 7. Is this to correct a violation? ❑Yes VNo <br /> 1O1 a' APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />