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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 /> JeDP I.%e. `$tA'n)(AY ❑ Zoning S s;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) // D estriction;CSM <br /> 4/5" / ,u_-'_... .q"_' ' e rIt% 441V12- w/53527 riance(# ) <br /> HOME PHONE C PHONE E-MAIL DDRESS <br /> 839 (Z i. Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME i D CONTRACTOR NAME <br /> xi et cow" tsurZ Ziip ef.r,,S ❑ Site Plan including location <br /> AGENT ADDRESS ADDRESS ell/septic <br /> SIG Ileywry�19r. <br /> (City,State,Zip) Ci ,State,Zip) Zacks <br /> ( tY P) <br /> sifK P>�;''t- wi 5-351V <br /> PHONE PHONE ❑ Site Plan oval from <br /> yyy 8773 a • le township: <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> p►�► R✓q• Q W ac).co*. ❑ F oor s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> p PARCEL <br /> NUMBER bib 7#-03y-28 D R —J czu D • 6,4/3 frontage drawn to scale. <br /> TOWNSHIP: //JJ SECTION: ` '� ❑ Drivew ermits <br /> !/fl �r G�-e. .3 1: SE WA: N <br /> ADDRESS: <br /> VVVVVV e,county,town) <br /> C1 7' G�jeb LCr / -SUBD SIGN k BAli S- 7 ❑ Sanita rmits <br /> 4!p ic,private) <br /> PROPOSED PROJECT INFORMATION 7 : <br /> PROJECTD SCR�IPTIOy� ��r� �( ",'" , � - , " - < <br /> ael+aQ' •2. OD ?'c <br /> . Va-6iis project is a new building or structure. f '- <br /> ❑This project is an addition/alteration to an existing building or structure. 3 ,-„,,,r;--,.,1-, <br /> SANITARY SERVICE: PERMIT NUMBER: �� 1 r <br /> ❑SEWER ❑SEPTIC ' ',� °1 , ,: <br /> HEIGHT IN FEET , / NUMBER OF STORIES: (Not including basement) r ,- , <br /> AREA TO NEAREST SQUARE FOOT: r F= <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: $ '7�4 <br /> X///4 4, TOTAL SQUARE FOOTAGE: ,j, 4 4 t-- <br /> 2ND FLOOR: 3RD FLOOR' ' . <br /> // N/� r_ - E� <br /> ESTIMATED CONSTRUCTION COST: -► (� lt,® - <br /> (Please round to nearest dollar) ���a V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes {,WNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes W No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 1 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Y s ®No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (I ve blank if none) <br /> 6. Is a location survey required? (see reverse) Yes rtiNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes N No <br /> i•A)(0 .. ‘ ---- APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />