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' t-6. sli‘'fb 5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAMEr)C CUSTOMER TO PROVIDE <br /> 1 \af '- <br /> OWNERADDRESS (Number,Street,City,State,Zip) �� Zoning Status;CUP; <br /> q 0 i O �r �a I J _ 5 ��, ►eed Restriction;CSM <br /> HOME PHONE CELL PH NE E-MAIL AD.RE Variance(# ) <br /> 2wa8o , 1 Il, ,� /�Gh oii 44y,;; <br /> AGENT INFORMATION �i et Plan drawn to scale <br /> CONTRACTOR INFORMATION :nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AGENT ADDRESS $ite Plan including location <br /> CONTRACTOR ADDRES .fi well/septic <br /> (City,State,Zip) (City,State,Zip) <br /> Setbacks <br /> XaSpitpeliPcalabnleatpopwrnosvhailpfr.om PHONE PHONE <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) <br /> PARENT PAR L NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑ PARCEL b ''0-1_ 'b3 q +o 1_J� rontage drawn to scale. <br /> NUMBER VVV t lJ ��� g <br /> TOWNSHIP: SECTION: r, <br /> � �\( t (2 ¼: S(/) %A: 5(/J <br /> •�,•rivewaypermits <br /> ADDIsS)'v S ;n ` a I 1 (state,county,town) <br /> CSM: LOT v SUBDIVISION BLOCK/LOT •/i'public, permits <br /> public,private) <br /> PROPOSED PROJECT INFORMATION 4 <br /> - � w .w <br /> � �PROJECT DESCRIPTION: <br /> • giThis project is a new building or structure. "�� - £" <br /> ❑This project is an addition/alteration to an existing building or structure. ft- <br /> SANITARY SERVICE: PERMIT NUMB R — , r -f <br /> ❑SEWER SPTIC . , v m <br /> -',HEIGHT IN FEET: <br /> NUMBER OF STO-IES: (Not including basement) - " 41.,E <br /> AREA TO NEAREST SQUARE FOOT: `�� � c( <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) n` = 2 <br /> BASEMENT: 1ST FLOOR U, ® 4& a <br /> 4, TOTAL SQUARE FOOTAGE: 4, �3 w s ,4g w ��j <br /> ,s e <br /> 2ND FLOOR: <br /> 3RD FLOOR: (100 <br /> ESTIMATED CONSTRUCTION COST: " -q- � <br /> (Please round to nearest dollar) '0 '0 "► –► [WO � s�� , :s <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IN o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tillo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? e'es ❑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 bled if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Mo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes /`'"� <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) –► –0. <br />