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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N I;0 k A k \, � <br /> G„(,,U� ❑ Zoning Status;CUP; <br /> OWNER Rs (Nun, gr�scjec city,State,zip)1A Deed Restriction;CSM ) <br /> c V/ !!��id eSt° c�IL, 9� Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> E'..16-S/9 9 7 ?0 ^0 0 90 •!)c -ri5,.tArt ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME A ` CONTRACTOR NAME <br /> WQ .0 l ❑ Site Plan including location <br /> AGENT ADDRES CONTRACTOR ADDRESS of well/septic <br /> L.Clf?/ /c�Se e Cr S' . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Wawv.o ee uj ; . <br /> PHO PHONE ❑ Site Plan approval from <br /> 3 ' Q applicable township. <br /> E- .‘1?ADDRESS E-MAIL ADDRESS <br /> / , is>. fYp.-- ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> PARCEL Foe--4 a 5/ -o frontage drawn to scale. <br /> NUMBER <br /> TOW P: SECTION: 1 ' 1 ❑ Driveway permits <br /> rf k S�% �% /`' �`�' (state,county,town) <br /> ADDRE6 <br /> ���/// ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION `z9 <br /> PROJECT DESCRIPTION: ( s� � <br /> r � <br /> : <br /> . 54,This project is a new building or s ructure. q�i r i" to <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ' °° �-s <br /> ❑SEWER .SEPTIC ° 4; <br /> HEIGHT IN FEET NUMBER OF TORIES: (Not including basement) b e� <br /> 11' G tt (/ v Ike i f,1 : <br /> AREA TO NEAREST SQUARE FOOT: <br /> -. Y- „ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: } <br /> / / / v 7 / 4, TOTAL SQUARE FOOTAGE: 4, �3 .,,,, � v <br /> 2ND FLOG 3RD FLOOR: �O ® ,, � , �1 <br /> ESTIMATE CONSTRUCTION COST: ALL <br /> s - d , <br /> (Please round to nearest dollar) -► -► -+ -* -* $ 400d eu "' <br /> ,, v <br /> Jt, aoa — <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? AYes ❑No ❑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 ❑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 to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Ilo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► —O. <br /> 545-112(4/08) <br />