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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 /> Gt)` 'i 1 417- `-6' ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) � g ' <br /> —2 - LY '7 �.,�t x_ t✓T� Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI ADDRESS / <br /> &G B -89—WC9 1 l d •ti )bt:L IJO t4rIX Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENA NAB CONWACTOR NAME <br /> Fl` S; ,d-"/-+ P,K)0+E' .' Ibt--4`' 4.,LL, igSite Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> -Zz6 S 7 L De <br /> (City,State,Zip) (City,State,Zip) LiGi Setbacks <br /> e"aly v 6/(7,':,_) C,../. - 5-365) <br /> PHONE PHONE ig. Site Plan approval from <br /> applicable township. 5("';'''.14.4-) <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 5-44-(e • i:I 4 64 aDe (.o•- loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P p rty <br /> ❑ PARCEL oq� /00/f 2-3/45D°_-5 A,r I Ey No AocCS frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> I))C4D4 5 1i✓(35 2-5 1/4: s w f '/.'/4: jJ E 4Drivewaypermits 'Scat{' <br /> ADDRESS: (state,county,town) ti-4) <br /> "2:2- 5' (&`'''ti 'Slo `-'��l"`J t,.- Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT ry p erm co`� �`¢ <br /> (public,private)` -pGgu- <br /> PROPOSED PROJECT INFORMATION <br /> �J � � <br /> PROJECT D SCRIPTIO : �I '/ - , 4 a af. `i <br /> . *This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 2 pr e ai <br /> ❑SEWER EPTIC ,Z ;',;4•:''�; a�' ' <br /> HEIGHT IN FEET: ` NUMBER OF STORIES: (Not including basement) p <br /> - I t U fz �)D6t' k -2, - . a,.. <br /> i , y ra is �el,1 fit. <br /> ,i,�.�Iv7ro �-oF-F f�l�°A s..v.,:=, � ����t�a ��� <br /> AREA TO NEAREST SQUARE FOOT: -c 7, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' " <br /> BASEME 1ST FLOOR: �� - <br /> g <br /> 1b6 6 Gr^Do 4— 00 ,j, TOTAL SQUARE FOOTAGE: 1 a` ai { a ,,� <br /> 2ND FLOOR: 3RD FLOOR: <br /> 27$5LFf 5 s(p „ 4A . , ., <br /> -,KitirtfAu... ,715.0.fAV,,A.. <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) -► .' --r "' $ . M a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes CA 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? 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 Q)No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Wo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />