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ZONING PERMIT APPLICATION w .countyofdane.com SUPPLEMENT to Web-App# <br /> ww <br /> PROPERTY OWNER INFORMATION` CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ChftS a- fY arrl( h1 lip Zoning Status;CUP; — 1 <br /> OWNER ADDRESS (Number,Street,City,Sta ip) _ _ geed Restriction;CS <br /> HOM 7 3 S�� O�� D E-MAIL ADDRESS t of, �L S3S�( Variance(# ) <br /> V.: ,0-7S - VP'i / , 'd/JGAlt,n n®J:' 01_ h ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACT°-NAME <br /> ili - A y 10.11. 1 ,A 0 Site Plan including location <br /> AGENT ADDRESS CO RACTOR ADDRESS of well/septic <br /> • <br /> (city,State,Zip) (City,State,Zip) ? 2 Setbacks 30/1-/ 0/5-0 <br /> 641),,&1 1»,,\r. W � <br /> I S2DS O <br /> PHONE PHONE p t Site Plan approval from <br /> O 5-77 39 '1'5 applicable township. /4_ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /L Floor plans to scale / <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P e rty <br /> ❑ PARCEL R frontage drawn to scale. <br /> NUMBER .2-21()(,ll�- 1-`13.�!7 • t` )� 1 <br /> TOWNSHIP: TI N: <br /> ��h n SEC___ '/<: 0 lA) %1A: L>,.;' i Drivewa itss A <br /> ADDRESS: �^ (state oun �y]'y`�/1' , <br /> a�3 Si PrVI,`CA'v1 ( �l `e 1 G y'`�, . �/`l_S ' Sanitary permits <br /> CSM: T SUBDIVISION BLOCK/LOT /VIA <br /> U (public,private) <br /> PROPOSED PROJECT INFORMATION . 9 <br /> PROJECT DESC IPTIOp :Z �," y+� 1 <br /> This project is a new building or structure. z ._ <br /> This project is an addition/alteration to an existing building or structure. , �'V <br /> SANITARY SERVICE: PERMIT NUMBER: ,, 4..-, <br /> ❑SEWER �''SEPTIC in ,4 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) P':::::". `° A- <br /> iC "� _ ` a(,j; ,- <br /> ® r a � a. <br /> AREA TO NEAREST SQUARE FOOT: , � - <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' ` <br /> BASEMENT: 1ST FLOOR: a <br /> TOTAL SQUARE FOOTAGE: 1 4 xi xg° � <br /> 2ND FLOOR: 3RD FLOOR: <br /> y . L ` Vie,::,q�',:: P 4 . <br /> �d &. mac" <br /> ESTIMATED CONSTRUCTION COST: ` � � ` <br /> i , DU17 , O. �`,� <br /> (Please round to nearest dollar) "'∎ --∎ "4. --∎ -* g 4, <br /> 1. The property is within 300 feet of a stream r 1000 feet fr pona or lake? XYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the erty? ❑Yes ANo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes t'No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes XI fo <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) CI Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICAUST BE- IGD <br /> (Continue on TION BacMk) P S ►NE-►- <br /> 545-112(4/08) <br />