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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 13 r-9n) /D "S, I- 0 L I-J ❑ Zoning St s;CUP; <br /> OWNER AD ADDRESS (Number,Street,City,State,Zip)n Deed striction;CSM <br /> 5-6/0 <br /> r,r P. I Va ' nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6 o L 4l 49 1c r i Z oN L 44 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ) CONTRACTOR ME <br /> wSE L V / b/er k .2(1/G r C. Z5 r) .572- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> X30 /-1Y / c7 Q3ag l-1 `f / . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> crcSS P14L./kJ G/Los; P -AI it/ <br /> PHONE PHONE ❑ Site Plan approval from <br /> -2T /7 - 1 c, c,- / 7 -7/ /applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> gi oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: 0 CURRENT ZONING: ACREAGE: P P rty <br /> ❑ NUMBER O 10 ��∎'N loon"J A^ I ,a,7 frontage drawn to scale. <br /> TOWNSHIP: SE�jT N: , 1 ❑ DrIVe <br /> •lJ lC f 'A: - 1/41A: S V permits <br /> ADORES te,county,town) <br /> 56 /0 2 .e/h e r / . 0 ,6&n PR.q r�r 6V w� ❑ Sanitary s <br /> SM: LOT SUBDIVISION BLOCK/LOT <br /> (p ' ,private) <br /> PROPOSED PROJECT INFORMATION 7- <br /> PROJECT DESCRIPTION: <br /> "i4","-.%. <br /> POo / 0C/ -e, °off° ' <br /> -This project is a new building or structure. ta <br /> ❑This project is an additi /alteration to an existing building or structure. - <br /> , <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> 5 <br /> ❑SEWER SEPTIC a �T t v� - <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ?- d -,..,f-,,, <br /> '� <br /> // ` 0 4' <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 /> 1/ S + TOTAL SQUARE FOOTAGE: ,+ e ,.,Ii, <br /> vC ,z _ ax a �� <br /> 2ND FLOOR: 3RD FLOOR: <br /> Pool = � <br /> ESTIMATED CONSTRUCTION COST: $ _'� , g <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ "♦ ♦ $ G e>(�, U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes lio ❑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'? 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 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? LI Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />