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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 /> 0.-s Perla 570q4 CPC. '"/'*'`"`' C. ❑ Zoning Status;CUP; <br /> : ERAD ESS (Number,Street,City,State,Zip) ^ Deed Restriction;CSM <br /> tl(oOS F4.4er ree v (l.oit v� /'r1�` {va� L✓ . S3 Z Variance(# <br /> HOME PHONE CE ' •t E-MAIL ADDRESS <br /> (Cal _fit- JI .4,8.3.33-�i4sy +'S', ^ O''v$ " e • Co LI Site Plan drawn to scale <br /> AGENT INFORMATWN CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> LI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> • <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: _c ACREAGE: CI Elevation of property <br /> NUMBER 910S°2 Off a0,s0-0 C- Z ��1D Z frontage drawn to scale. <br /> TOWNSHIP: SECTION:9 <br /> P 1A: ow 1/41A: ❑ Driveway permits <br /> (state,county,town) <br /> ADDR SS: <br /> CSM: LOT S BDIVI IO BLOCK/LOT ❑ Sanitary permits <br /> !0 ( (public,private) <br /> PROPOSED PROJECT INFORMATION �4 Y <br /> PROJECT DESCRIPTION: <br /> This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. ° � r <br /> SANITARY SERVICE: �. PERMIT NUMBER: ,� � .�e s � ��`+� <br /> ❑SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> y S <br /> AREA TO NEAREST SQUARE FOOT: = <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) E"` <br /> BASEMENT: 1ST FLOOR: <br /> + TOTAL SQUARE FOOTAGE: j <br /> 2ND FLOOR: 3RD FLOOR: 4 � t <br /> ESTIMATED CONSTRUCTION COST: oe � � <br /> (Please round to nearest dollar) 3`�p‘ 1. � � _� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ©No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? aYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 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 0 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> erg_ <br /> 017B <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —* —► <br /> 545-112(4/08) )".rE ZPIAC E f Si olt 4 C.,/U1-T- <br />