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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ---7 I <br /> — )t. , .vt.t e rt21et1 1 <br /> OWNER ADDRES (Number, treet,City,State,Z _ Zoning Status;CUP; <br /> 21117 7 6c (� u �2t r; IfU T 3 SC10 Deed Restriction;CSM <br /> Variance # <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Variance(# <br /> 8Z-5-8/ 7a 33---j 33e.,8 . z_ 29ci7 ,i,iso . CeJ,v1 <br /> ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACT NAME <br /> ��wt-e- 0.S d�'1 Q C(k Vtite. 0.S O(o✓12I W4ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) aS�etbacks <br /> PHONE PHONE PSI;Plan approval from <br /> ( pllcable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS 'c <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: I Elevation of property PARCEL❑ <br /> NUMBER V <br /> 10 0' A- I Ex C 1 vvS4 frontage drawn to scale. <br /> TOWNSHIP: ,. SECTION. n , <br /> �� A?(Ct,, C t [` / (0 +/4: /U E .1/41/4: / rivewaypermits <br /> ADDRESS: (state,county,town) <br /> 2L-►ct7 /3LL )� y Rd 5tk� Iic«,r��, w� -33`0 <br /> CSM: Q LOT SUBDIVISION BLOCK/LOT <br /> ❑ Sanitary permits <br /> { (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: 01 1 r <br /> ViTiO4 —?J %vle <br /> Uli Res ',� ii aP a ? -1 <br /> ❑This project is a new building or structure. <br /> XThis project is an addition/alteration to an existing building or structure. , , ff ' <br /> SANITARY SERVICE: PERMIT NUMBER: ' ` (040,12,0,;. _ �:' <br /> ❑SEWER SEPTIC ^:', „ : <br /> HEIGHT IN FEET <br /> NUMBER OF STORIES: (Not including basement) , - �- <br /> ` y ,rg �.xv .�, <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,- <br /> BASEMENT: 1ST FLOOR: ( �� , <br /> f � ' s., <br /> ` TOTAL SQUARE FOOTAGE: 1 �+ �d � 4 ��' <br /> w '2ND FLOOR: 3RD FLOOR: Z-7 O d , N <br /> F ` <br /> ESTIMATED CONSTRUCTION COST: /� g . : .< <br /> (Please round to nearest dollar) $ 9 Z 3 V O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 10 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? pkies ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ayes ❑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 o ❑Don't know <br /> 7. Is this to correct a violation? Li Yes SEttko <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► <br />