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ZONING PERMIT APPLICATION w .countyofdane.com SUPPLEMENT to Web-App# <br /> ww <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ��-Y r/ L Ir�A k <br /> OWNER ADDRESS (Number,Strlet City,State,Zip) ❑ Zoning Stat , , <br /> a 5SO w. S fcL r f2C e ki- �<< a estriction;CSM <br /> l °� ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4')3 —$ 3 J G 2€-55C 3 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site PI uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS I/septic <br /> (City,State,Zip) (City,state,Zip) Setbacks <br /> PHONE PHONE LI Site Plana val from <br /> • e township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F or plans to scale <br /> PROPERTY/LOCATION INFORMATION <br /> ^ � (http://acc essdane.co.daAnCeR.EwAGiEun [y"Elevation of property <br /> rty PARENT PARCEL NUMBER0 � RRENT NIN,G x❑ `(r 1^ "NUMBER <br /> frontage drawn to scale. <br /> TOWNSHIP: SECTION: ` � <br /> y i�'.aS'ctn.`1L S pt c A s zi 1/4: I J vJ %1/4: V�/ ❑ Drivewa urtits� <br /> ADDRESS: O \' e,county,town) <br /> vp. i r c cS , ❑ Sanity Its <br /> CSM: LOT SUBDIVISION BLOCK/LOT iC,private) <br /> PROPOSED PROJECT INFORMATION 74- <br /> PROJECT DESCRIPTION: <br /> . ❑This project is a new building or structure. i'� ii �;4 : <br /> This project is an addition/alteration to an existing building or structure. ' :� � <br /> SANITARY SERVICE: PERMIT NUMBER: �i' - :- <br /> ❑SEWER SEPTIC c^ 4' �V ' 4 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> is I v ii ) <br /> ® I a M <br /> AREA TO NEAREST SQUARE FOOT: x . <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � '' 4 <br /> BASEMENT: Q 1ST FLOOR: t ® ;fg�1 el,k1 rtes_ 1 3 X 8 �� TOTAL SQUARE FOOTAGE: 4, t-:,-.',4.,..,7,.0,� �r- t,,-- � � <br /> VV i a. . .V ,7�; * <br /> 2ND FLOOR: 3RD FLOOR: y ) •- <br /> ESTIMATED CONSTRUCTION COST: a g � 3 <br /> S �� . ;a �3 <br /> (Please round to nearest dollar) "� ..1.:.i..., <br /> o <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? ❑Yes 3 N ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1No <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 8No <br /> APPLICATION MUST BE SIGNED <br /> 545112(4/08) <br /> sq r — (Continue on Back) ♦ —► —► <br />