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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 /> /vi1V /e�r ZL_ ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ��� Deed Restriction;CSM <br /> ✓`'Z3il /f/i4T j �>'Z -��'Ul//�e/'1/,, , 535-90 variance(# ) <br /> HOME PHON/ // E� CELL PHONE E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME f CONTRACTOR NAME <br /> c7 x1V C a„ -� / <br /> if 1° ✓ ,�,L ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ID •X 2.>� f /74 X 2�jJ . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> T '7Z 6f ‘;`27- („e/, 57752.---- <br /> PHONE PHONE ❑ Site Plan approval from <br /> 9 /5.9 �� 5 °Z`/d applicable township: <br /> E-MAIL ADDRESS <br /> 6 izi/ g 476‘, (2-es/)----- LI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUPARCEL MBER t/ y'� , i)_25/-028-6 3.474 frontage drawn to scale. <br /> TOWNSHIP:: SECTION: <br /> J____ Ge72. �,G 1/4: / E %.1/4: ,,5--7.a ❑ Driveway permits <br /> ADDRESS: f� I'� (state,county,town) <br /> 523'' 4/V7-el/ZS Liz.-- ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> r (public,private) <br /> L> / f/iL,F/- (e-Ats it b'41 t> <br /> PROPOSED PROJECT INFORMATION e : <br /> PROJECT DESCRIPTION: _z f <br /> ❑This project is a new building or structure. <br /> jai This project is an addition/alteration to an existing building or structure. .- �� <br /> PERMIT NUMBER*SERVICE: r a <br /> ❑SEWER 4ISEPTIC .SgO 6,75 a a Ai&I`C ” "- '' <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (Not including basement) N <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 6A4"Oaf T <br /> g52 352 f.. V/1;. 4, TOTAL SQUARE FOOTAGE: 4, r r ''' <br /> ® r�s , <br /> 2ND FLOOR: 3RD FLOOR: //. Z �� <br /> s a fl,,- <br /> ESTIMATED CONSTRUCTION COST: <br /> ♦ ♦ ♦ ♦ ♦ --► i� , - p • _ rrs1 7 <br /> (Please round to nearest dollar) ] Cl .. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Z No ❑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? Ii3 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes di 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 tisio ❑Don't know <br /> 7. Is this to correct a violation? V ❑Yes SENo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i —► —0. <br /> 545-112(4/08) <br />