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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEfAME <br /> 411i7e i2Aai,, ❑ Zoning Status;CUP; <br /> owapii t (N�`be,s/A Zip) `r �. x� L Deed Restriction;CSM <br /> !// / Lcr/ � ` �?. ;/C/XL Variance(# ) <br /> HOM PHONE CELL PHONE E-MAIL ADDRESS <br /> 'ei ..air "i Alf4 ' i 1,-, t er V � <br /> "' stli ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> t.sagine ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <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 ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CUR NT ZONING: ACREAGE: P P rty <br /> PARCEL D � q/ .r 3 . ,r4 frontage drawn to scale. <br /> NUMBER �'7 <br /> TOWNSHIP: SECTION: <br /> lej9 lY/iti V tayS ,44. ,/,/4: ❑ Driveway permits <br /> -5.0- <br /> ,� (state,county,town) <br /> ADDRESS: 2 / �� <br /> �cJ//OIL G/�w'�4• r i `cr. -- 16/2 air* ❑ Sanitary permits <br /> CSM: LOT S B•IVI I•N 00//' BL'CK/LOT (public,private) <br /> %I/_ <br /> /. /. ‘ '/, <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT D CRIPTION; r s , � <br /> . El This project is a new buildin or struct e. e'= <br /> This project is an addition/alteration to an existing building or structure. � r � <br /> SANITARY SERVICE: PERMIT NUMBER: - 0° = , "," <br /> ji(SEWER ❑SEPTIC y tt r <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) - <br /> vi.µ ®kta •r°�. 3 - s <br /> AREA TO NEAREST SQUARE FOOT: 0 -'_ u <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) . 4= <br /> BASEMENT: 1ST FLOOR: ` , <br /> t� tssi + TOTAL SQUARE FOOTAGE: + W a 4:14 <br /> 2ND FLOOR: 3RD FLOOR: ' as , <br /> ESTIMATED CONSTRUCTION COST: ; <br /> (Please round to nearest dollar) -4* --► --► ✓✓ qtr a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lees ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lif< ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? l' es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Milo <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) Wes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes arclo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />