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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER 6 <br /> 4C'+'RFS ❑ Zoning Status;CUP; <br /> OWNER DDRbSS (Number,Street,Ci ,S6te z n ') v I 351? Deed Restriction;CSM <br /> /l(J`tl�'Fr�- rf r S J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL A DRESS <br /> bob,`W7-(z�l �y'1'fq 5 W d yid" • e ivy k--c. nit— ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 5CO++ Za hkV ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (city,State,Zip) (cNhStat�LZip) 14-web, �i ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTYILOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: Ct-RENT ZONING: ACREAGE: ❑ Elevation of property <br /> `�PARCEL 054 /y)i_^1 _71`_ 97 L frontage drawn to scale. <br /> T NUMBER It)W (� <br /> TOWNSHIP: SECTION: <br /> S reAVv 1/4: %IA: ❑ Driveway permits <br /> 4 <br /> (state,county,town) <br /> 0 P�V�QrD^ , D,"(� veigo , C 3 /il <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> Rai/0 O t__ 6 4' .V AJ SC O . .- 9 <br /> This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. F f : <br /> 1 =�� <br /> SANITARY SERVICE: PERMIT NUMBER: �`.'� `���°' '" � ' � <br /> ❑SEWER ❑SEPTIC _f ;R` -a s <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) : .' �'�� , <br /> 4.1::(41q,02' q ) 4 ' :. <br /> AREA TO NEAREST SQUARE FOOT: 7: '' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) fr '° <br /> BASEMENT: 1ST FLOOR: ® , _, <br /> 3[0 4 TOTAL SQUARE FOOTAGE: 4, . �i w E 1t" � �` <br /> VV a ® ,;, ,; �» ,7 <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3�C7(� r e r >s <br /> Cam/\�J _ &�"�ffi`,' 1�+ �' <br /> ESTIMATED CONSTRUCTION COST: z $� <br /> (Please round to nearest dollar) � .C� � -, �` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑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? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />