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- ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> • V WIN Q.S V tl G i \Q,r• `M Zoning Status;CUP; <br /> OWNER ADDRESS umber,S reet,Citt tate,ZIp Deed Restriction;CSM <br /> Ti'?` c) iar , Jcno 1) P r^ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ii * , (°q0' '- I3 6 'te Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION . d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> • Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,state(Zip) V! Setbacks <br /> PHONE \ PHONE 1 site Plan approval from <br /> -pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS t.;�. s <br /> �� loo'pa t. cafe <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) k, evation of ro e <br /> PARENT PARCEL NUMBER: ) Q CURRE ZONING: ACRE GE: (� p IJ <br /> ❑ NUMBER o v 1 b - to/ —J b/V--.7 7 ` / t. O I frontage drawn to scale. <br /> TOW SHIP: SE TION: <br /> V , 1/4: 0_ - 'n'/: k_ �`,0 Driveway p- its <br /> ■ADDRESS: (state,c• nry,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> cUbIIC, iii-1��_` <br /> S' >r1 *u r � 1 <br /> PROPOSED PROJECT INFORMATION may, <br /> PROJECT DESCRIPTION: , 1 - <br /> . NI This project is a new building or structure. <br /> _ fit <br /> ❑This project is an addition/alteration to an existing building or structure. c, x <br /> SANITARY SERVICE: PERMIT NUMBER: '� �°' o �° <br /> a'tt❑SEWER 2�SEPTIC , a� m ' ' A <br /> HEIGHT IN FEET: \ NUMBER OF STORIES: (Not including basement) - �5- 3 <br /> ,.,5.5%.,-,-` ai l <br /> AREA TO NEAREST SQUARE FOOT: .2 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) -a, ' - T <br /> BASEMENT: 1STFLOOR: ' s '.. , �� <br /> , TOTAL SQUARE FOOTAGE: j �d �� <br /> 2ND FLOUR: - O� �� ''',1..1r9-4,61". <br /> p,,,,,,,-;„:,,,T, <br /> � c� 4r.: q �= � # . <br /> fr ESTIMATED CONSTRUCTION COST: Q� r « c�a a a � � <br /> (Please round to nearest dollar) -► •P ? --,,.. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes El No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes fANo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 21No <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) io,Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 2XNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► <br />