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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 /> GOT d0 Pcr 1 S (Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restric' . C7M <br /> 3 6 L/4/ 0 iO OA a .y-- CA-- Variance(# ) <br /> HOME PHONE CELL PRONE E-MAIL ADDRESS <br /> • <br /> . # ' i, c F' Site Plan drawn to scale / <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dim I scions <br /> AGENT NAME CONTRACTOR NAME <br /> \\N-qer` CO,,.S1- -UCc-av,,, Site - - • - ding location <br /> AGENT ADDRESS CONTRAC5ORADDRESS l � - <br /> 7.1-0 mUrACn/� S'�' /► �/ 3 11/D 00 �l <br /> (City,State,Zip) (City,State,Zip) J _ +/J�JO�Setbacks J <br /> PHONE PHONE �( CX S 37// Site Plan approval from if <br /> 609 -'7S 90 32 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS / <br /> �C v.� t . C9SicG 6 , l I Floor plans to scale / � <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) / (/�I/� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 174 Elevation of property <br /> ❑ PARCEL rontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP SECTION: <br /> ��1 l 0^— '/<: 1/43/4: Driveway permi e <br /> ADDRESS: state,county, ow �(10/4 <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary •- 1/ <br /> (publi•,p •vate Y <br /> PROPOSED PROJECT INFORMATION y t E <br /> PROJECT DES IPTION: 4 f <br /> I <br /> \�1 vrk s t( ct_ -e— �0 <br /> ❑This project is a new building or structure. ,- „,...Pan***Atiorgemelf- 4 <br /> ki_This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: . _ <br /> ❑SEWER ASEPTIC <br /> HEIGHT IN FEET: / NUMBEIj OF STORIES: (Not including basement) j <br /> 1` �i <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) -` <br /> BASEMENT 1ST FLOOR: r � � ��, <br /> �3/� + TOTAL SQUARE FOOTAGE: + 1 <br /> YYK 6 J <br /> 2ND FLOOR: 3RD FLOOR: 33 �{; <br /> ty y <br /> ESTIMATED CONSTRUCTION COST �f � �f�lV/ <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ `�1 000 U(� �„ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No L Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No C,IitDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? LA Yes Li No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 4 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 ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes 0 No <br /> APPLICATION MUST BE SIGNED <br /> o� (Continue on Back) -► <br /> 545-112(4/08) /� <br />