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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION <br /> -- - `- - CUSTOMER TO PROVIDE <br /> OWNER NAME Q <br /> Peal U OT 14 - ❑ Zoning Status;CUP; <br /> OWNER AD SS (Number,Street,City,State,Zip) <br /> J , �� / / Deed Restriction;CSM <br /> SCf�3 �4tre0te-r l , ddLde'Mu GJr S3s'-G 2 _ Variance(# ) <br /> HOME PHONE CE PHONE E-MAIL ADDRESS <br /> 7yc IS'f 0 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME 9ONTRACTOR NAME <br /> .E.i)AUI Es 4' S'vS ito,NO.14445 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> '/809,skiI iilo e le-J <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> ∎love v4 Los 537 G <br /> PHONE PHONE ❑ Site Plan approval from <br /> 608— z z z -6461 applicable township: <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.usl) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> 0 PARCEL O��ou�/LL'r 4_ / frontage drawn to scale. <br /> NUMBER 7 7 <br /> TOWy IP / SECTION: IA: 1 ' ❑ Driveway permits <br /> ADDRESS: <br /> HI /177 A) /•/•: (state,county,town) <br /> gyc,1,/*rr _ ❑ Sanitary permits <br /> „f 0 309 LOT ' SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION R t IE1l1f , t <br /> PROJECT DESCRIPTION: '' <br /> f�uSe n��i Tjo.v to X `� . -. , , <br /> is project is a new building or structure. ," r <br /> ❑This project is an addition/alteration to an existing building or structure.' �- �jr' -� , ` <br /> SANITARY SERVICE: PERMIT NUMBER: 2 ° � s a <br /> ❑SEWER ❑SEPTIC a a Li �-�` t <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Not including basement) '� <br /> 42 1 v�� a . ®id a mr - t,ent Y�' <br /> ' '� ® ,� 9tt i_ 1 rent :. <br /> AREA TO NEAREST SQUARE FOOT: •" ,b- <br /> (Outside dimensions including unfinished area, -iu► ed garages and above grade decks or porches) r <br /> 'j�{ r r£?s onCO <br /> o 1ST FLOOR: tillte�(/�� ifg <br /> , TOTAL SQUARE FOOTAGE: 1 ,,S.9 e ,1- $ r s •a W �;3.2ND FLOOR: 3RD FLOOR: `1 ® �k <br /> i Nei; jjgv,� lMaw 7Zo 47 :.., - ..,1 .-70,, <br /> ESTIMATED CONSTRUCTION COST: Q . i O a®n 4›,,,t ;` ,`-z= <br /> -► -► -► ♦ -► ' i <br /> (Please round to nearest dollar) /, % / � ��� =n� � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Flo ❑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? ❑Yes ®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) B'es ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [•No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -∎ -► -i <br /> 545-112(4108) <br />