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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO P;VI DE <br /> OWNER NAME <br /> � �1�/,, �J L-L . <br /> Zoning Sta <br /> OWNER ADDRESS (Number,Street!Cty, to ip) Go,. -- <br /> J� ` D e striction; CSM <br /> al/7/�� /G--� r� f e <br /> t-P-1 S r23 riance(# ) <br /> •ME PHONE CELL PHONE E-MAILADDRESS <br /> O -3'--- '��°`�'�"' �-' #/ "Sr— //'1� S' e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT M 7--------- CONTRACTOR NAME d 1� j �G�`rp /ell/sePtic Plan including location <br /> AGENT ADDRESS CONTRALTO SS <br /> (City,State,Zip) (City,State,Zip �i baClCS <br /> �..,. ,l„�ye �-fir z 3 <br /> PHONE PHONE ❑ Site P pproval from <br /> 7 `�2 3 �a c� <br /> cable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> o�7 �' Io Sij'v`ccj tau, loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENTZONI G: REAGE: EleVatlon Of property <br /> PARCEL ® �oz-Y• '4, _6 G-.o- '4 .� frontage drawn to scale. <br /> NUMBER <br /> TOWNSH P: SECTI � N <br /> S3-. ,/4,/4: ❑ Driveway permits <br /> A�/D°Dl'R��E}S-S: i�/C�s' , (state, county,town) <br /> CSM: / / O�K�� SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> l��I (public,private) <br /> PROPOSED PROJECT INFORMATIONt <br /> / <br /> PROJECT DESCRIPTION: � �W, �� <br /> This project is a new building or structure. ���� ® s � � . <br /> Li This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ddress <br /> SEWER SEPTIC ? 3� <br /> ., 'Y„3 4IF <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) . ` <br /> AREA TO NEAREST SQUARE FOOT: ,d 0 „s <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) }a: <br /> BASEMENT: 1ST FLOOR: �9`fie a t r.. <br /> � ���� 4. TOTAL SQUARE FOOTAGE: ,� 's,, y,7� r§ ,• <br /> 2ND FLOOOR: 3RD FLOOR: /� ` e aG ). <br /> ❑ Rev ecatton wey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) "* /o 3 eJ)t) -vane 10 S' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes . o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o Won't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1Tes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes .$I�o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 8�.3� ) (leave bla�n�k iiff none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes _ No <br /> A(Continue PPLICATION on Back) ♦MUST BE SIGNED <br /> 545-112(4/08) <br /> -► <br />