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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAI ,'■^`0' S <br /> OWNER ADDRESS (Number,Street,City,State,Zip k Zoning Status;CUP; <br /> (o 9° Cc0.'c t?C - �9Crcon , u3 Z S-3s 3`l Variance Restriction;CSM ) <br /> HOME PHONE CELL PHONE kJ E-MAIL ADDRESS <br /> p•• 4-KS 0 co, -ago .- S ,(L ( 7 Z: C)(aCOt - , ' t'^"' - c r"r" - tePlandrawntoscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S0.rA.Q_ - Eite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE M Site an approval from <br /> ap icable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Aloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ►i Elevation of property <br /> PARENT PARCEL NUMBER: CURRANT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL Q S a__)S a_ S N al_ /-1_ frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: i SECTION: ' <br /> P Ito )\O r 1 S 1/4: 1^ W 1/41/4: N 01 Driveway permits <br /> ADDRESS: �� (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT anita ells <br /> (pub AID <br /> PROPOSED PROJECT INFORMATION f� <br /> � <br /> PROJECT DESCRIPTION: <br /> ' '1 <br /> 8C Ce e h6OSQ ± <br /> . ❑This project is a new building or structure. i� �, <br /> This project is an addition/alteration to an existing building or structure. :;_ „o- �¢ <br /> SANITARY SERVICE: PERMIT NUMBER: L :1 tit, e°to :, <br /> ❑SEWER ► EPTIC ` a 0 I = a ::"a�s,-a : � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) >_ "� <br /> ,^q° . .l Kai- r m <br /> AREA TO NEAREST SQUARE FOOT: - '; <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a d <br /> x . e 7 <br /> BASEMEN� 1ST FLOOR: <br /> S r---) 4, TOTAL SQUARE FOOTAGE: , ii � y, <br /> 2ND FLOOR: 3RD FLOOR: LIS E <br /> ,74..~, riarSiitziii74 , <br /> ESTIMATED CONSTRUCTION COST: .' . <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 12(No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes AV() ❑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 XiNo <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) DYes 21No Li Don't know <br /> 7. Is this to correct a violation? Li Yes 0No <br /> Si PPLICATION MUST BE SIGNED <br /> 545.112(4/08) '/S 5,)-- fh>' 7 . �(Co/ntinue on Back) —► —► - <br />