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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME -�' <br /> v�� �/ �01 y ©��0<4) <br /> ■ Z ing - : 9 a C P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 7/✓" A/ /l C,(-'5% �vt/ D�P a-✓ G�// D ed c i ?t n; CSM <br /> 5 riance(# ) <br /> HOME P ONE CELL PHONE E-MAIL ADDRESS <br /> 6 o7J 75(2 0 ,S'-7.$x-12 ° Ageo(lsys-re,.-rs e 7O.NIi} it Plan cjC i to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION a include§dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite PIa i uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/se is <br /> (City,State,Zip) (City,State,Zip) etbVi( <br /> PHONE PHONE El to Plan - ,gr_ •- <br /> pplic- • e o . 9. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn e•Elevation of ro <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p <br /> ❑PARCEL frontage draw • scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • <br /> '/4: '/a'/4: ❑Drivewa • r '', <br /> ADDRESS: 712 /f/// -es r z_,‘/ (stat o n) <br /> CSM: '-r LOT SUBDIVISION BLOCK/LOT ❑( private) I <br /> (-ub • private) <br /> PROPOSED PROJECT INFORMATION ' <br /> TAFF REVIEW <br /> ` <br /> PROJE/T DESCRIPTION: r <br /> f'iaYri A-90/7741-11 ! onng Dsc , <br /> . ❑This project is a new building or structure. C Permitted Use' . .: <br /> DThis project is an addition/alteration to an existing building or structure. , <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural dy re s �0 ,; <br /> i <br /> FIEWER Y Y"TIC .0A.,.'t r (new/ xisting "0 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) u" , -.•_. i;;•-.:' <br /> ` Co ( ❑ Wetland rsdplaipI ,.. ��:; <br /> AREA TO NEAREST SQUARE FOOT: SF10rel ! (at ' • ent) . <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r Ero • <br /> ❑ sionCon u •l permit <br /> BASEMENT: 1ST FLOOR:/ S� eVd rbanoe `. <br /> 10 + TOTAL SQUARE FOOTAGE: j r( p � r <br /> ..fillingta• ess) .. <br /> * a ``3 <br /> 2ND FLOOR: 3RD FLOOR. ® d ,< <br /> Reviewtlon SUrvey <br /> ESTIMATED CONSTRUCTION COST: GCe —�. and available options <br /> (Please round to nearest dollar) ♦ ♦ --► ♦ ♦ ♦ $ i/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 120o ['Don't know <br /> 2. Is there a wetland or flOodplain on or near the property? [Yes 2l o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EV-es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes JIo <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 li f to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ,zfNo - <br /> si <br /> : � _ APPLICATION MUST BE SIGNED <br /> 41 /3 0,Le° �`. (Continue on Mack) ♦ —► <br /> 545-112(4/08) , '� - <br />