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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> _IAM,.3 6• A50665147 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Stttatt ,Zip) �� RD Deed Restriction;CSM <br /> 01.9 HO PHONE MAPLE C ELL He t C hE-1MA�ADDRESS D Variance(# ) <br /> 92A—L.1. " 13 I i a 63-5191- ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ 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.ciane.wi.usn <br /> PARENT PARCEL NUMBER: �URRENT IN): ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL 06 I Z ,./I I_�L0.� Z 2-CA frontage drawn to scale. <br /> NUMBER 1 <br /> TOWNS P: SECTION: ❑ Drivewa <br /> GA) NA , I 1/4: !YE %1/: ., y permits <br /> ADDRESS: <br /> (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 7(2,57 (public,private) <br /> IJ:ZQ:L*1.14BAJ*111X 101:11•1:1i1tEldt4. 4--, ,� ',i-1,71,- I <br /> PROJECT DESCRIPTION: , <br /> „ <br /> . 7A ....au KL a c v :�.'5 <br /> . a This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. ;Y,----- ,?.:-.'''' ' 41 <br /> SANITARY SERVICE: PERMIT NUMBER: ''' 4,f I e _ ' <br /> ❑SEWER SEPTIC i � � I x <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> '''''',7'.1-70-i":,. ...,- <br /> AREA TO NEAREST SQUARE FOOT: fir, ." <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ' TOTAL SQUARE FOOTAGE: j i - - € - ''m <br /> -.,, e s �y <br /> 2ND FLOOR: 3RD FLOOR: ;k; ® ' � ' , <br /> 32.0 <br /> ESTIMATED CONSTRUCTION COST: 313Z ell � , ." ,q <br /> (Please round to nearest dollar) ` ,-;:-,,,,,04... - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes pNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 0Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI Yes Lii 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 L No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes c4 No <br /> O; 0 75- <br /> -- 2-L( APPLICATION MUST BE SIGNED <br /> S (Continue on Back) -► -0 <br /> 545-112(4/08) ..--•-"--------- <br /> 7 If_O U <br />