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ZONING PERMIT APPLICATION www.countyofdane.com 4SUPPLEMENr,#o lAleb App <br /> AOPERTY OWNER;INFORMATION `� w ` <br /> _ ' ��-� �..-�„�,;_ . > � -.� --• CUSTOMER TO PROVIDE <br /> OWNER !ME <br /> I '� 1\11c, 11e iv\-e �I-e{ oningStatus; CUP; <br /> OWNER ADDRESS (Number,Street,City,Stat ,Zp) Deed Restriction;CSM <br /> c3-2 ' c r/4 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> S• Plan drawn to scale <br /> AGENT IN,FO_RMATION. CONTRACYOR INFORMATION M-A,r,,:= and includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME <br /> S' Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> • <br /> (City,State,Zip) (City,State,Zip) backs <br /> PHONE PHONE D Site P a oval from <br /> - appli a wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> P.ROPERTY/LOCATION INFORMATION ,(http llaccessdane co_dane wr u's� ;: x , <br /> t PARENT PARCEL NUMBER: CURRENT ZONING: AC vation of property <br /> DPARCEL \\ <- 1 ontage drawn to scale. <br /> NUMBER s -7 )U' " SS 1 P— / F <br /> TO HIP: SECT1O <br /> 1 %4: %<'/4: El Drive y rmits <br /> AD J (stat unty,town) <br /> D Sant ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pub• , •Vate) <br /> PROPOSED PROJECT INFORMATION � $t'AFF I1E-cilEW *{ <br /> PROJECT DESCRIPTION: ] siv s,, -+tt� ' <br /> 1. 1'3 <br /> G�f ��) )°C t_ t onl gDI ct ;l r1_ri: <br /> '.Rt cal 3-�f�}�"' r .sG '`a <br /> ❑This project is a new building or structure. ri > ,� <br /> m tfet�U_seF <br /> This project is an addition/alteration to an.existing building or structure. _ __- <br /> .r` -..max. :.. ., :r <br /> uralAd� ~" , <br /> SANITARY SERVICE ♦♦ PERMIT NUMBER ���� � y� 'e• �' " t <br /> �EwER 1��-EPTIC I� .; (new s ng < i : .,- <br /> HEIGHT IN FEET I NUMBER OF ST IE (Not including basement) = -.:6 �he <br /> P v,...3 1 t.::- 4.Wetlar d/Flbodp alr " <br /> :-7---.. J Sporeland .(a`ttachment) <br /> AREA TO NEAREST SQUARE FOOT: ,,. , 'f' %° <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porch== >0 E o.6F6 u. <br /> • • '1-, <br /> BASEMENT: 1ST FLOOR i,:.--.1„%...'"-77.0-3-., "+ . - ,4'''''. 4.s, <br /> 4, TOTAL SQUARE FOOTAGE sopes,ci One <br /> 2ND FLOOR: 3RD FLOG fi aCCeS5 � <br /> �� <br /> " 5 <br /> r d <br /> . <br /> * <br /> ESTIMATED CONSTRUCTION COST: -i -i ♦ .9. .9. _.0. $ /1 2- nd a ailate op to ` <br /> (Please round to nearest dollar • <f =t7 ` V <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes LINO DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes DNo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Dyes DNo <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) Dyes Elo DDon't know <br /> 7. Is this to correct a violation?- DYes Llo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -11. -lb. -► <br /> 545112(4/08) - <br /> • <br />