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ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App# <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNS AME <br /> V%IA.:se___* CZ)N.A s—k_ 6.\-NrI�C9N'1 I ing Stat ; UP; A /' c <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ <br /> Ilea 5 .� )114G-4,%5(1,-- -4 . �0.sk £jAL WI- • cestriction;CSM <br /> �l / ���1� Variance(# ) i <br /> HOME PHONE 3W3 CELL PHONE E-MAIL ADDRESS �/ <br /> -1 tO�-3W3 5 le-9 s7(C ei Site Plan drawn to scale / =4/0 <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Qc-uE— r INko.- dv`. O S 3 $ '.,01 Sites �-- ' 0,...' • location <br /> AGENT ADDRESS CONTRACTOR ADDRESS off septic <br /> ,DL(r Kcr:2t` .∎ Dr . /t�5 <br /> (City,State,Zip) (City,State,Zip) %Setbacks / <br /> PHONE PHONE Site Plan approval from / �� <br /> gL{?-- a So v applicable township. !'" <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> d,Lv-e_e yA1Lw y �son f{p y�,tes, . ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT Are, UM21.32:_i / 1 CURRENT ONINGACREAGE: ❑ Elevation of property❑ PARCEL 9` lt� � �/ Zl v frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP. _ 1n .�\ SECTION: IV / ,per <br /> B IC—CAC-- 204-�- CG .1/4: +' ,/.'/.: S N/ A(Driveway•- -it ni/4-- <br /> ADDRESS: // ,_c�� �/ r/J ( • �✓ <br /> C/J (/ //�//v (Sanita ry p A/XI--- <br /> GSM: LOT SUBDIVISION BLOCK/LOT public, <br /> PROPOSED PROJECT INFORMATION ; <br /> PROJECT DESCRIPTION: 1, ", "� ` <br /> • 7 This project is a new building or structure. a � g <br /> ❑This project is an addition/alteration to an existing building or structure. ' ' ' <br /> a -- .. <br /> SANITARY SERVICE: PERMIT NUMBER: v : '�� �° ,, . <br /> ❑SEWER SEPTIC '' : g i v- <br /> �°'fi � 'i �'i <br /> HEIGHT IN FEET: /� NUMBER OF STORIES: (Not including basement) 7f-4 t <br /> AR TO NEARES SQUARE FOOT: g °:' - �' �I <br /> F <br /> (Outside dimensions including unfinished area,attached gars es and above grade decks or porches) t 4. gr d ��15-.BASEMENT: 1ST FLOOR: • <br /> j TOTAL SQUARE FOOTAGE: l ` ® �i ,',;il,,� am ) <br /> 2ND FLOOR: a 3RD FLOOR: / <br /> ' / A , ' <br /> ESTIMATED CONSTRUCTION COST: _ *� <br /> (Please round to nearest dollar) ♦ ♦ ♦ "� '0 '♦ - g, � <br /> ( ) $ 30 per � � , • - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ID Yes ,PsrNo LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? r Yes to.io ❑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? ❑Yes Ail 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) g■Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? CI Yes .'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -► <br /> 545-112(4/09) <br />