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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION' CUSTOMER TO PROVIDE <br /> OW ER NAME <br /> IAlct AEL— SCJ-MMO .--k <br /> L ,f, oning Status;CUP; <br /> OWNERADDRESS (Number,Street City,State,Zi RO®\�L ►- 6u1 ►'eed Restriction;CSM <br /> 53P WI P,J ,l''��L_L V-00� z\ 1 Variance(# ) <br /> OME PHONE CELL PHONE E-MAILADDR SS <br /> b- SS- *0 bo2-1 l2 Z. I e invC} . . _. A et- e,-\ .! <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ii-P.AA--- lk Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • well/septic <br /> (City,State,Zip) (City,State,Zip) g etbacks <br /> PHONE PHONE L 'ite Plan approval from <br /> pplicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,11, Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.whus/) Elevation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ NUM ER 0S/° /..,Lj q O�v ff _ /Y,x 1 S frontage drawn to scale. <br /> �WNSHIP: SECTION: v I <br /> ID^ ,.pp�, `� f 1/Q: C.. 1/41/��i,J R' Driveway permits <br /> ADOREt;s,'~1� (state,county,town) <br /> $ `"lu'19 lLL Z). "' 12-0 Y( ")\ S2 ❑ Sanita •ermits <br /> CSM: LOT SUBDNI O BLOCK/LOT (pu priva <br /> •r <br /> PROPOSED PROJECT INFORMATION ' <br /> PROJECT DESCRIPTION^: ,gyp � f � �' ` <br /> CPO I S _1 LE 2] gqi y?��,< <br /> This project is a new building or structure. °' �h <br /> ❑This project is an addition/alteration to an existing building or structure. �� <br /> SANITARY SERVICE: h'=` lets _ "--. �, <br /> PERMIT NUMBER: .�� . � �' <br /> ❑SEWER EPTIC ,V �°. ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ' " �� <br /> 1 g• iv`1Q� I V'' aw <br /> AREA TO NEAREST SQUARE FOOT: ,. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' , <br /> i BASEMENT: 1ST FLOOR: a ® • " <br /> A ,� TOTAL SQUARE FOOTAGE: 1 , 4• , $°" rte- , <br /> • <br /> 2ND FLOOR: 3RD FLOOR: , <br /> 0 ti p" Fes' <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) "� $ �, !- b •f-7,f: :, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tallo ❑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 o <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 .SNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ystNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) ter- <br />