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• ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTQM ER TO <br /> `=-r RO' <br /> VIDE OWNER N E Uf 0/d hd C /7.€,-y// Test,eel/ Ife onin Status;CU P; C'`/ <br /> OWNER ADDRESS (Number,Street,C ,Stat6, <br /> Deed Restriction;CSM <br /> -5-7 9 2 / 4,, !/ /4''`t - Variance(# ) <br /> H ME PHONE CELL PHONE E-MAIL ADDRESS <br /> /t—,2//iz)/ <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME j� CO; CTOR NAME , <br /> `f<FT ' !� 'L`--ege,-/ 23744/d-.3 4e- ''g Site Plan including location <br /> AGENT ADDRESS CO RACTORADDRESS of well/septic <br /> 5/9717f. Y9/O /2e/h,% 720/ . <br /> (City,State,Zip) (City,State,Zip) / 3 ft Setbacks <br /> /117C 1�.�'4✓i -.5-^. s- <br /> PHONE PHONE : Site Plan approval from <br /> tr 6:d g-- 8-37-//70 .pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS > / <br /> ..�{f-� p-,� - _c„f`jvCoC.g. eve III Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCELN9MBER: CURFfTZON G: ACREAGE: P P rty <br /> ❑ PARCEL ®/t?/,,�j/p-23 2-194-94-F /-4--1 P' � 7,2 rontage drawn to scale. <br /> NUMBER 0/!JD! a 7 (� <br /> TOWNSHIP: SECTION: <br /> .)d0 9 AAA/ 1/4: /t 1/41/4: Id Driveway <br /> st- <br /> ADDRESS:9 <br /> a4ectee,,/bm ce ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT ' (public,private) <br /> PROPOSED PROJECT INFORMATION , <br /> PROJECT DESCRIPTION: ;': " : L , ` <br /> This project is a new building or structure. -_� . <br /> } <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ,G-mot!( ; <br /> ❑SEWER yg-SEPTIC '" 'r 1e-r. a 0.P '" <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ..V/ r// <br /> 1 .i , t) <br /> AREA TO NEAREST SQUARE FOOT: ,:p:.:-,,,.. - <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) V �- , <br /> BASEMENT: 1ST FLOO': - $ <br /> 1 - �O r• 3C.)3C 4, TOTAL SQUARE FOOTAGE: g.r y- <br /> 2ND FLOOR: 3RD FLOOR: _ � <br /> ----7giEXA7 i::Y--2. 714.: -.;:-,:':,:::,-_,,,,,_ESTIMATED CONSTRUCTION COST: QQ�� ® _`� $ <br /> (Please round to nearest dollar) —* ""∎ ""+ $ y/S/ Q 0 °�� <br /> i3N -biro Lo,ke <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo ❑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'? gees ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0-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 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes iertio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -i —r <br /> 545-112(4/05) <br />