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• <br /> • <br /> • ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER Nf.ME /k V g! e—i /k r iLer-fo ise_s , LL.e d Zoning Status;61 <br /> OWN ADDLRE�S (Number,Street,City,State,Zip) �.. <br /> ( 4. HOME ONE 'C ONE MAILADDRES G /60 - 96) 3- s1- -. 473 S <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME G CONTRACTOR NAME <br /> 234-or Lc Tr c.e# - ke/��Z c //eg ,-/ c Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wellisepti,C <br /> w 177 f(9 '5 E 4)er ve4- Dr w/9-7 N 9gsz, !Pl tfe!-c re9 (3 <br /> (City.State,Zip) 5 u r')4 /4/4/ (City,State,Zip) Sag A' /O G/ Setbacks <br /> l.Tc-+d-Lot--40 w n . LC/t (3 O?� Ge r-n.4 0/7 GV i'1 / v<.41- S 3 O,-A ,_,r <br /> PHONE ,„2 C? , 4, _ F�/0 — 6 PHONE LA Site Plan approval from <br /> c?-63 - t q - fi o,--G - c 076;2- -99y -89� applicable township. <br /> E-MAIL ADDR SS E-MAILADDRESS <br /> ( (� ttt_c ' //Lev,u,'d'S.. /4, ecI,� jlQ/"A /A .,c.pi..,. g Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) []Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> LI NUM ER 0ii(M/a -057f -9Z -e)-/ C-- d- 7 X�,s frontage drawn to scale. <br /> TOWNSHIP: SECTION: . _c /4( 1 S( 4 Driveway permits <br /> 3""'�� �4' (state,county,town) <br /> ADDRESS: <br /> CSM: [�/� LOT a e0 SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ; a <br /> 4 <br /> PROJECT DESCRIPTION: „�J� /� / .- �� <br /> This project is a new building or structure. .' 1 0 ' <br /> • ❑This project is an addition/alteration to an existing building or structure. „-_-',„.----__;`,:,4-7- <br /> i � f. <br /> SANITARY SERVICE: PERMIT NUMBER: i° . ” <br /> K <br /> 4SEWER CI SEPTIC ` ,,,� <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '' t` =" ` ' <br /> BASEMENT: 1ST FLOORS- <br /> : <br /> /� 45 ,c, 4, TOTAL SQUARE FOOTAGE: 4, f <br /> 2ND FLOOR: 3RD FLOOR: >_ <br /> ESTIMATED CONSTRUCTION COST: �� 4 , <br /> (Please round to nearest dollar) -P --► "'∎ '∎ ∎ j 0,'` s � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? kl Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 4 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Z ❑Yes ❑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 14 Don't know <br /> 7. Is this to correct a violation? El Yes XiNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />