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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 /> a 444 E . $ v e u m ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number. reet,City,State,Zip) <br /> S <br /> S3s�� Deed Restriction;CSM <br /> ASS /.�;rpurf �l �1�� �r�/ i�1 Variance(# ) <br /> HOME PH+NE CELL PHONE / E-MAIL ADDRESS / <br /> O ' &2/-06 f s mar) ahp(OCsPq, W i sc. f-a u( ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME p <br /> ' U r}Ge BU r5 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ' ?G /uz-2,0S ti ritt t <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> CT Ski PZ.,4FAS Ust's.2 <br /> PHONE PHONE ❑ Site Plan approval from <br /> Ddb x,79 _016 I applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> t-f- 2_01 Qi.,C 1--6,,.r4 cerd je.- ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ctane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAG ❑ Elevation of property <br /> ❑ PARCEL �3$/116Si-asf -T A _J I • frontage drawn to scale. <br /> NUMBER f� <br /> TOWNSHIP: SECTIO : LI Driveway OF 04 1/4: Or, WA: y perm its <br /> ADDRESS: <br /> (state,county,town) <br /> ((((�a�� /4-zeP RO' Ptiocke ( .vi _ ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> rokiAt+5 , ; (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> F I r t <br /> PROJECT DESCRIPTION: t / x - - <br /> -;,- <br /> . ❑This project is a new building or structure. ''1 � ' <br /> M This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 2, ®a : *. <br /> ❑SEWER SEPTIC ° a, <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) . -, ' , ' <br /> AREA TO NEAREST SQUARE FOOT: ® *:4x <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , s, <br /> BASEMENT: 1ST FLOOR: a r <br /> ,, TOTAL SQUARE FOOTAGE: j, r I 1; �'� <br /> s <br /> 2ND FLOOR: 3RD FLOOR: 2/0 <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) "� 012 e), r a; - _ ----, <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 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? CA 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 ErNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes vii No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -* <br /> 545-112(4/08) <br />