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, , P19 GE / oft <br /> 1.0.-P 71 <br /> . . <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / <br /> ff? 171Omas 09 $ infirm . l Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 72 2O C/O ven //,'L-Z. pc) tie Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> `2'tseli 8 / 4 ' ..�NL ErSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5-6'a7 P.F4/7x- / f jL iev <br /> (City,state,Zip) (City,State,Zip) ❑ Setbacks <br /> u/au-Nakee lAT S-JC?7 <br /> PHONE PHONE �/ �/ ❑ Site Plan approval from <br /> g3/— %�l ' applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ 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 /> ❑ PARCEL oc/0 o-_/6y_vg/0-S 2.v1 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1PR„vy ; a /6 . 4: 5 1/4'/.: NW LI Driveway permits <br /> ADDRESS! (state,county,town) <br /> 722.0 C/oveA '/ Da%d/e <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> o/ ?CY �lcko,t I,Avg <br /> PROPOSED PROJECT INFORMATION q '' <br /> PROJECT ESCRIPTION: ' , <br /> Co <br /> . ❑This project is a new building or structure. gig -� <br /> This project is an addition/alteration to an existing building or structure. ,;- a <br /> SANITARY SERVICE: s e°4*_ '�° <br /> ❑SEWER SEPTIC `;'i ,a � <br /> k1 ' , <br /> HEIGHT IN F T: v� NUMBER OF STORIES: (Not including basement) :':2"�� 1 .s � ' �. <br /> AREA TO NEAREST SQUARE FOOT: - <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r <br /> BASEMENT: 1ST FLOOR: ', • <br /> 1 92. /9A 4, TOTAL SQUARE FOOTAGE: 1 i i ' 'z-.?. <br /> '. <br /> 2ND FLOOR: 3RD FLOOR: Ov <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► ♦ ♦ ♦ $ l g D0t� <br /> (Please round to nearest dollar) " Fs <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ZNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? JA Yes ❑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 gNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 4 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />