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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME ebrr v e `/firer <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Num er,Street ity,State,Zip) �� Deed R • Ion;CSM <br /> 5-Sa _ ,4. e�f- //7 vary / , ' nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /0/ — �^ /4' Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGE �/� CONTRACTOR NAME <br /> Q/9 ME/"(�// <br /> Si Plan including location <br /> AG TADDRE <br /> D�/ CONTRACTOR ADDRESS o well/septic <br /> (cit ' 'rP),J5,a/ !/Y�tJ� ity,State,Zip) Setbacks <br /> PHONE ❑ Site Plan a al from <br /> 7,91- 375--q1,5-/ 7 applic township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> A v ,07L/47 "oz., G owl ❑ F oor s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of property <br /> PARENT PARCL MBER., �1 / CURREN NI : ACREAGE: P P rty <br /> ❑ NUMBER O36/6#49 3-7/ ('j�,j / < 6s frontage drawn to scale. <br /> TOWNSH SECT • <br /> ��J� <br /> ��� eaP /y 1/4:5Y.�' %1/: /11, ❑ Drive ermits <br /> ADD Ess: (� /� ate,county,town) <br /> 3 Fjp7 /�/an�/a/r 7/-. /��/ 1,Xf"C�//ly/...z. ❑ Sanitary•- its <br /> CSM: LOT SUB,D ON BLOCK/LOT/ . <br /> / 6 Si DI IVI// e/e1/' e ,private) <br /> PROPOSED PROJECT INFORMATION ;7: - <br /> PROJECT DESCRIP ON: : 4� <br /> ❑This project is a new building or structure. z <br /> ,This project is an addition/ Iteration to an existing building or structure. - " <br /> SANITARY SERVICE: PERMIT NUMBER: k-.,'R a1e"i - <br /> ❑SEWER SEPTIC ""s- n .,`` <br /> ""'4'- } �. z " .ice K> - ; <br /> HEIGHT IN FEET A NUMBER OF STORIE?: (Not including basement) n ` • `� _ ' <br /> AREA TO NEAREST SQUARE FOOT: 4 - -;, �7�rym <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: 4,/,_ 01 1 4 ® : , <br /> 4, TOTAL SQUARE FOOTAGE: i 4 �l �gv,� yi so" <br /> 2ND FLOOR: 3RD FLOOR: 1, 3c),1 ,,- i ® � : <br /> $§ irs � <br /> ESTIMATED CONSTRUCTION COST: ��� p 6 �h ° ., - <br /> (Please round to nearest dollar) ♦ ♦ "♦ ♦ "♦ –∎ <br /> l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dyes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 'dyes ❑N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank f ne) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> c) ' r— APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ –► <br />