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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 /> C�P6\e,R t'`cx( -- ❑ Zoning Sta ,CUP; <br /> OWNERA D ESS (Number,Street,City,State,Zip) . D e Striction,CSM <br /> � \ C \, -R 4 riance(# ) <br /> H OM HE CELL PHONE E-MAIL ADDRESS A <br /> • % • %- a IN <br /> te •a _ \ - 1 ' . - S e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> cie , � ` Site Ian including location <br /> AGENT ADDRESS CONTRACTOR AD ES of ell/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> fie_\\eU\\\Q \6\ --- <br /> PHONE PHONE ❑ Site P -n approval from <br /> app !cable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS I <br /> ❑ 'loor ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usr7 L Elevation of r <br /> PARENT = URRENT ZONING: - P opertY <br /> ❑ NUMBER ._ • -r , ` frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ` `T �C7�9��3 ❑ Driveway rmits <br /> 0,.\ { 1 '6 W 1�4: � ) %1/4. 3 <br /> stat oun ,town <br /> ADDRESS: 1 \'� G ty,town) <br /> \ \ • I �� `l��"` . ` v ' ❑ Sani :ry p- its <br /> CSM: LOT SUBS IS ON BLOCK/LOT (pu•li .rivate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: -.- ' c <br /> -% _%'r\ tb, r h ors i SN ' c..-\; a..* - 6-'C : <br /> ❑This project is a new building or structure. 4:',-‘-',.:-,, <br /> This project is an addition/alteration to an existing building or structure. ., <br /> SANITARY SERVICE: PERMIT NUMBER: e ai" �4 <br /> R, <br /> ❑SEWER JXSEPTIC :4'1 + �, . ' <br /> HEIGHT IN FEET: ic) 1 NUMBER O STORIES: (Not including basement) �': � � <br /> ,:i ® :139.`.7 <br /> AREA TO NEAREST SQUARE FOOT: tr <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ^ W � 1 <br /> cot 4, TOTAL SQUARE FOOTAGE: ,I, 1 4" W 1 1, <br /> A'7 'm s • <br /> 2ND FLOOR: 3RD FLOOR: *1 CC t � , <br /> ESTIMATED CONSTRUCTION COST: <br /> riitomii;40'..::,,t*Ial <br /> . , <br /> (Please round to nearest dollar) " ' "� v..< )���� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes N*10 LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ANlo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? tgYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 14 No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave bl nk 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 o <br /> ,------ APPLICATION MUST BE SIGNED <br /> sasttz(a/os) -4 '7 ' (Continue on Back) ♦ —► <br />