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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 /> �.oVia Gj,c�i.✓ �Sr,oT- "iilz-ip p/c-/), (/_°X_,) <br /> _ Xoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> 1_9.77 S-7;-;-.c-L,e-o— .end '�' � �/ s-3 r8 <br /> /SIG FA ! O,LO Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> W Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION :nd includes dimensions <br /> AGENT NAME / CONTRACTOR NAME <br /> �y/`"'P 5`4_,-/A/ 4ti._piU / -N S Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3 f' yT ,oed 5 rim • <br /> (City,State,Zip) (City,State,Zip) *Setbacks <br /> ., 7-r, ,,csGico,-6 S-3SZ7 ,r,0 1-10 <br /> ill.ONE PHONE ❑ Site an approval from <br /> /66e) SS 8`e..' / S--6 H4.- ap icable township. <br /> :MAIL ADDRESS -'/C.,//a E-MAILADDRESS <br /> P23'5 / -•,4 G Ce jL . Gw/� �-°,0/'fa.- Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBS CURE NTiQNING: ACRE E: Elevation of property <br /> 0 PARCEL °7/1 1/ t4-Sson 3 K H_ j A frontage drawn to scale. <br /> NUMBER / JIJI J° <br /> TOWNSHIP: / SECTION: <br /> C r-t-Af I'a� 1/4: S ,/,/. ,I/ J; J Driveway rmits <br /> ADDRESS: (state, unty,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary rmits <br /> (publ' ,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: -'' �, <br /> il 0,-cse Mogi" v41 02c. k tilic,b----, :;,...2,-;.,ii:itii4roltii: '!ii.f::'• :'.:::-'-, :i7L=i-::.3, <br /> LI This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> � a s � <br /> SANITARY SERVICE: PERMIT NUMBER: `' 1 r <br /> ❑SEWER EPTIC � a�* <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> x `� <br /> � ►.y4 <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' a 14" k <br /> BASEMENT: / 1ST FLOOR: , , <br /> eV/0 4, TOTAL SQUARE FOOTAGE: .` ' g� <br /> , <br /> 2ND FLOOR: 3RD FLOOR: ' <br /> ' <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) -0. -0. "0. $ ° �. ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes 'No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'No ❑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? LI Yes g 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 0/No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 443o <br /> o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -0. -O. <br />