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• c------y7 ^ 404 re/IAA/IL SI/lee iiesd - c,? <br /> 9i/tA44tol °01 at K) • IL.fa <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �> gT A { 0% Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> 1 qN ev( 1 '45 ad. 5 .ti,,4-c.., i LA.'c--. 5359 Variance(# ) <br /> HOME PHONE CELL PHONE -MAIL ADDRESS <br /> 6i V13- bq C4'k 3687 I 5,ete Plan drawn to scale i , n <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Rose b ,; C. M Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1'72- f{-J,( t3 - . <br /> (City,State,Zip) (City,State,Zip) LWSetbacks <br /> .S7`O LI h l-sn i tJ; c?579 a <br /> PHONE PHONE 3i e Plan approval from <br /> G o 1- F73-- S O 6 F a (cable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Flo r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) ation of property <br /> PARENT PARCEL NUMBE CUR ENTZ G: ACREAGE: P P rty <br /> D <br /> NUMBER DG(I ISi � oD O . - 1 A 4 qo,f. ��: frontage drawn to scale. <br /> TOWNSHIP: SECTION: { <br /> •Du>1 kirk '/a: %IA: J Driveway permits <br /> ADDRESS: (st e,county,town) <br /> • c C % (;, Rot .<4-o �[�k .34 t w. S3S.9 Sanitary permits <br /> CSM: LOT J SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION 17 <br /> PROJECT DESCRIPTION: _ '1,.'_ "'e.. Is project is a new building or structure. t` :te 1 s ?a v <br /> ❑This project is an addition/alteration to an existing building or structure. ,_ <br /> SANITARY SERVICE: PERMIT NUMBER' Q -���4 ,-- <br /> ❑SEWER .SEPTIC S j V 0-7 1 - 1�/ a'a -., - . <br /> HEIGHT IN FEET: NUM ER OF STORIES: (Not including basement) .' f ., <br /> AREA TO NEAREST SQUARE FOOT: ,C= �Y <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a 1 : . <br /> BASEMENT: 1 T.FLOOR: � _ <br /> Nowt_ 3��� 4 1 t t ,, TOTAL SQUARE FOOTAGE: ,�, 7 11,• e“�, t. <br /> 2 D FLOOR: 3RD FLOOR: a- s' <br /> rt,r -c 3 L <br /> ESTIMATED CONSTRUCTION COST: �J J�//�/ 4f...41 . , <br /> -► -► -► --► -� --► $ /� V l l - - ,,a r(Please round to nearest dollar) l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 4- ❑Yes WiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? - ❑Yes kiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ...J Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? i..... ❑Yes RNo <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 ISr No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ■ - <br /> sas112(4/06) <br />