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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 /> bans el 4, ■ ctnC4 S\ k ) K&. ❑ Zoning S s;CUP; <br /> OWNER ADDRESS (Number,Street.City,Slate,Zip) a estriction;CSM <br /> dt d" C-0 -l v y e 1.i_r S 3 S l 6 dance(# <br /> HOME PHONE C L PHONE E-MAIL ADDRESS <br /> 601- a - S 3 , 1G1 r)c sh)-0 62 5-h)-0 62 ghee. c6 M S'a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S'a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ to PI cY proval from <br /> 'cable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CUR ENTZON NG: ACREAGE: P P rty <br /> ❑ PARCEL b • ,)( frontage drawn to scale. <br /> NUMBER U Sv it-36,1 -CJ y co-G .11 � <br /> TOWNSHIP: SECTI • <br /> err %: � '/.'/.: ❑ Drive <br /> ADDRESS: <br /> ate,county,town <br /> dc1 Cs 1-114, 2C-," , 31c,ncl,N4r(b) ( ►I e ws <br /> ❑ Sani ermits <br /> CSM: 'LOT SUBDIVISION BLOCK/LOT iC,private) <br /> PROJ CT DESCRIPTION: .3 X U 0 A rk° � s <br /> OF his project is a new building or structure. = ' •• . <br /> ❑This project is an additi /alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: v"r° ' - <br /> ❑SEWER SEPTIC -�a-m <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (Not including basement) -2 <br /> AREA TO NEAREST SQUARE FOOT: R <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1©0 <br /> ,, TOTAL SQUARE FOOTAGE: ,, <br /> 2ND FLOOR: 3RD FLOOR: <br /> y 6 /�\ s has <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 &I No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 14 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 0Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? L3 Yes titi No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />