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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE&NAME, <br /> btOrin d- J h11L Far insW o y1//' ) <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 11 ( 'I A) , .Jot r�0 Variance(# ) <br /> HOM PHONE CELL PHONE Gat U E-MAIL ADDRESS <br /> (ad '(0 ' ) (oo/5ai 'ISq( ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> A,'It Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE J / ❑ Site Plan approval from <br /> O 0 0) 14114— <3,5g b a plicable 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 N MBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL 0 1 8 -g i p t A-1 6/ 20 acre, frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: , SECTION: <br /> town 1 (.o e Gf c}Ve- Alt 1/4: S Nf 1/41/: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1 1' /V J Gt r 10 0 Deer,ge(d V1/1 535 <br /> CSM: LOT l 1 SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION S <br /> PROJECT DESCRIPTION: p 4' s -� <br /> I�eD��{C2 Ctt! /lh� fob-4 �Drc/1 w/ Wt QfQ`u� top "Sg95 s � <br /> ❑This project is a new building or structure. �3 :; <br /> .This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: , <br /> ❑SEWER SEPTIC -- <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) a � � <br /> AREA TO NEAREST SQUARE FOOT: -� - <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) l <br /> BASEMENT: 1ST FLOOR: ��V <br /> TOTAL SQUARE FOOTAGE: ti a) €�t <br /> 2ND FLOOR: 3RD FLOOR: ©� r <br /> �M1 <br /> s R <br /> ESTIMATED CONSTRUCTION COST: ms' - v <br /> a <br /> (Please round to nearest dollar) —► —0* __• -► -0' <br /> aSt 004 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes A No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes I No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No (t?-1' f <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? )1Yes ❑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 allo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes KNo <br /> _ APPLICAUSE IGD <br /> (Continue on TION BacMk)T B—►S♦NE—► <br /> 545-112(4108) <br />