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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 /> ENCYMi l 5 v' ` t-C 'T s GS c tic lti ' "3''`4 ❑ Zoning Status;CUP;OWNERADD ESS <br /> umber,Stree City,State, p^) �, <br /> �� �a VL 1 1aA 15 U3,i- 5- -1 t I Deed Restriction;CSM <br /> t Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL A9ORESS cha f-`•�f <br /> 2-0- 8-G 655- 2,t5-6-7 B2_ Svltcde'ho nd .C00-\ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG NAME CO CTOR NAME <br /> G O5 a rnL c S abDV<_ ❑ 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.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: A RAGE ❑ Elevation of property <br /> ❑ PARCEL 64.0/ Off/.8661"7 A I . c�UfeS frontage drawn to scale. <br /> NUMBER <br /> . TOWNSHIP: SECTION. <br /> 1„�..,,da`,e us 1/4: `Jt 1/41/: NV,/ ❑ Driveway permits <br /> • Aot::: ss: ' `II"".�iI (state,county,town) <br /> CIO�O� ` �u irnv�3 r"- ❑ Sanitary permits <br /> CSM: Ler SUBDIVISION BLOCK/LOT <br /> b 8 o " (public,private) <br /> PROPOSED PROJECT INFORMATION r .1,-.;"):7°,-,4-, <br /> PROJECT DESCRIPTION: „ { <br /> Jet d Cfr�S So l�t rt! - <br /> th This project is a new building or structure. t 14 to • <br /> • ❑This project is an addition/alteration to an existing building or structure. ', � <br /> SANITARY SERVICE: PERMIT�LU M BE R: - z' , _ �'� <br /> ❑SEWER tS SEPTIC bl EN1 D 1 ;' '- <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement <br /> Sr <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 /> '5"7 �, TOTAL SQUARE FOOTAGE: �, tip rl ,, � ,, <br /> # t ` x <br /> 2ND FLOOR: 3RD FLOOR: .^ `°"" ` " <br /> { t 2 .7f mars <br /> ESTIMATED CONSTRUCTION COST: - , _ „ <br /> (Please round to nearest dollar) —,4V-':Cr—', <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? ❑Yes .2fNo ❑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? ❑Yes 'I 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 .No <br /> QAPPLICATION MUST BE SIGNED <br /> ((G..•��''' (Continue on Back) —► —► —► <br /> 545-112(4/08) <br /> "ry, I°1- 0 <br />