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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 /> (A, , c,r> E,L L ❑Zoning Status;CUP; <br /> OWNER ADDRESS'(Number,Street,City,State,Zi Deed Restriction;CSM <br /> /0 cu. I, 5+ d. / ' All 7 J m e. C.} t S 5-4, Variance(# ) <br /> HOME PHONE CELL PHONE 'E-MAIL ADDRESS <br /> c St`• 75 S' N ' 3 C ' 'bo 6 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG NT NAME CONTRACTOR NAME <br /> ti,(.„ t ??-e I *..4-4 SC q r t t\e_ &ram T t e.. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /ao.a.c, 4- Ri, I1 N42-13 Sch ■rvne RA <br /> (City,State,Zip) (City,State,Zip) 4.17.- El Setbacks <br /> .r� <br /> PHONE P NE ❑Site Plan approval from <br /> 6?t!:)3' .7 95-- 41P-13 l Ra) 4'72- -2 3 iT 0 applicable township. <br /> ,e, E-MAIL ADDRESS E-MAILADDRESS <br /> e F t' ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/ 11 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL )Thy _t03_i S�- S ,A-_ ' '2 /--' 7 frontage drawn to scale. <br /> NUMBER �J J �P <br /> TOWNSHIP: SECTION: <br /> (Y\4 Z o M h „ , t GJ '/4: 5 '/4'/.: Drivew% <br /> ADDRESS: <br /> (state P d l } ) <br /> f Aa o (0 E. '4 K at e-N ❑San" „p <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pub ) l _ <br /> PROPOSED PROJECT INFORMATION . 7.-''',4.-Z E ..,-..c.,,.;- <br /> PROJECT DE IPTK)N: ` i• - s - 4 a" ` "�, 1 <br /> i rot a le U , •.1eh°,.14 ''.'-. <br /> . gThis project is a new building or structure. e- '0 „ <br /> OThis project is an addition/alteration to an existing building or structure. -lr.V ' <br /> SANITARY SERVICE: PERMIT NUMBER: C� ' e','4i, y ? P <br /> (EWER rEPTIC ,\J(7 ' <br /> HEIGHT IN FEET: t2„NUMBER OF STORIES: (Not including basement) s` <br /> : �t)t 4 f IY 4• e �� <br /> AREA TO NEAREST SQUARE FOOT: w0 ! — ��, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) °' 4,' „ r�5 <br /> BASEMENT 1ST FLOOR: 10 11 1 X e"I e ' ' e e e It , �` <br /> c.� e ftr.z <br /> -70" 4 TOTAL SQUARE FOOTAGE I :• ale 1. e ' o m ��`;�,'' <br /> 2ND FLOOR: 3RD FLOOR: + 4 p -. 't ,' <br /> �-/�0 'g am y <br /> �, e r t o t I' a 4"Fs-: <br /> ESTIMATED CONSTRUCTION COST: ( : e e t <br /> (Please round to nearest dollar) '♦ '♦ ♦ ♦ ♦ ♦ $ L (00 ,-, , w. -- : S. . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EINo 0)on't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Iles 10 ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EINo <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 Jlo Jon't know <br /> 7. Is this to correct a violation? ❑Yes [ Io <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -o. -+ <br /> 545.112(4/08) <br />