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i <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> a IPA- e- Street,m's ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number, ' City,State,Zip) Deed Restriction;CSM <br /> HOME PHONE CELLPPHON � E-MAIL ADDRESS Variance(# ) <br /> i ` - 1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (JLrj1/►'t t- CervsravenviV 560--r'r roefut ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 418-47 Pr.Q(L ih L 477 Pi yen.-eev,cte <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> e-artrigq6- <br /> PHONE j / ���2 L' LI Site Plan approval from <br /> (Qcl_ •615--ei{r. -27 061 039 - 35 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ID ElevatlOn of property <br /> LI NUM ER U✓✓I _ (32, - -0 4 I-- cr. 4-Z frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> TO aid.0F Vi, Aivr* I2 %: Vj 1/1/4_ �t)ri� ❑ Driveway permits <br /> —F"� (state,county,town) <br /> ADDRESS: /' ), <br /> 17`/'d K-,osh r%&/Q A., ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION : <br /> PROJECT DESCRIPTION: <br /> . -This project is a new building or structure. sip 4 , ,- <br /> ❑This project is an addition/alteration to an existing building or structure. �- <br /> SANITARY SERVICE: PERMIT NUMBER: I : a ' , <br /> I <br /> ❑SEWER EPTIC '/ 99 9.. .. ..:% .;._.:,,vi <br /> HEIGHT IN FEET j NUMBER O STORIES: (Not including basement) �- a <br /> AREA TO NEAREST SQUARE FOOT - :« g <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 9 - `'��` <br /> BASEMENT: 1ST FLOOR: < ® o : € <br /> �..-- Z Q q/ 4, TOTAL SQUARE FOOTAGE: 4, „ . i ...H74;:4 � <br /> 2ND FLOOR: 3RD FLOOR:7 , Y " � <br /> ESTIMATED CONSTRUCTION COST: g , <br /> (Please round to nearest dollar) ti <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes 1 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No Jon't know <br /> 3. Have you talked with the township about your project and are they in agreement? 4Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes gi 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 NNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes KNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4. -i <br /> 545-112(4/08) <br />