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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION' <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> -,iO f f ç‘ vL . ❑ Zoning Stat • <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 'l 5 3 c` ?, Dee striction;CSM <br /> 7S�$`'I 30 3 Cr� L N V coo GvLr / riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6Cr ls 41,21 bOr C7 liiVO f f s/0-, •r4c r.Ai rT <br /> ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Er'/C (N.4'-if" JSI(e Plan including location <br /> AGENT A"II RES� Z y i 6 S,ei„'7 7Q, CONTRACTOR ADDRESS of well/septic <br /> • . . <br /> (City,State,Zip) ` (City,State,Zip) Setbacks <br /> 0/01..4--, t� S3S'73 <br /> ONE PHONE ❑ Site Pla TOVaI from <br /> I i_=.5*.9 7( cable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> f r5/ 14,1"t/ &fi ❑ o ans to scale <br /> FROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT P CEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> V.PARCEL 060r-1-73-770D J�f Rik— / Z,L1'3 j— frontage drawn to scale. <br /> NUMBER /S�f�6 <br /> TOWNStIIP: <br /> SECTION: / <br /> V l ecv-,-%., 5 tt) 1/4: S`r /1/: ❑ DrIV erm its <br /> ate,county,town) <br /> n <br /> )ADDRESS: <br /> Ar 75—e', '/03c c,f- Ll✓ (•rev N.. !i'J.S 3S'-C'3 <br /> ❑ Sani .• •ermits <br /> CSM: e,s ( LOT SUBDIVISION BLOCK/LOT • IC,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJ:CT DESCRIPTION: t . <br /> . This project is a new buildi or structure. _ 2 ' z <br /> ❑This project is an additio alteration to an existing building or structure. , <br /> SANITARY SERVICE: PERMIT NUMBER: S`� a1 � � <br /> ❑SEWER SEPTIC , �■HEIGHT IN FEET: I NUMBER OF STORIES (Not including basement) :J 8 �f <br /> ��tr :;,-.-.4 :'', <br /> .��y <br /> AREA TO NEAREST SQUARE FOOT: r: �V <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,. , <br /> BASEMENT: 1ST FLOOR: ® c <br /> 4, TOTAL SQUARE FOOTAGE: 4. - I { ,� � <br /> .,ye ® � <br /> 2ND FLOOR: 3RD FLOOR: ? 0 <br /> , <br /> ESTIMATED CONSTRUCTION COST: �1'� <br /> (Please round to nearest dollar) ��) OV <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? C Yes ' No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 2+Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? BYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? clg& ❑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 �-EtNo LI Don't know <br /> 7. Is this to correct a violation? ❑Yes zEl' o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —P —P <br /> 545-112(4/08) <br />