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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> GU e.S t Jbonth e <br /> co ❑ Zoning Status;CUP; <br /> O E A DRESS(Number,Street,City,S Zip) _ Deed Restriction;CSM <br /> 5005 Reeve BlacK UaKfh WI 535/5 Variance(# ) <br /> Her/' J <br /> pf oNF 0 55 CELL N6/5 S` E-MAIL ADDRESS <br /> C`(t/(�' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME NTRACTOR NAME <br /> f ecrea-ThY1 I ft <br /> Ur(OS ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 0.I IV Main Sf • <br /> (City,State,Zip) (City, ,zip) C ❑ Setbacks <br /> PHONE PHON 575 ❑ Site Plan approval from <br /> 5— �7 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> PARCEL /'�Q/v -3(�^Orf50-�l t )_ 5,7 G frontage drawn to scale. <br /> NUMBER VV, IIJJY6 I aO f) I <br /> TO SHIP: SECTION: <br /> Ia6k E-OOr -h 1/. /1/. ❑ Driveway permits <br /> (state,county,town)5 Reeve Rd ( ty, ) <br /> 5 0� ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> o-3 Ig <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: E ' ,• <br /> . yj This project is a new building or structure. 'its; ,. � <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: " 1s4 <br /> PERMIT NUMBER: �"4:';'., )6�,�� <br /> ❑SEWER ❑SEPTIC ° � 3 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: '' , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ' <br /> BASEMENT: 1 ST FLOOR: * W b <br /> �� � , s+, TOTAL SQUARE FOOTAGE: + ,, Y t <br /> 2ND FLOOR: 3RD FLOOR: <br /> (9t4g z. -°#.. x 4 - <br /> ESTIMATED CONSTRUCTION COST: QQ�� cx� ; ., it ' i5 ,` <br /> (Please round to nearest dollar) '♦ ♦ --0. ♦ "♦ '"'0. $ 2'7 CLc) <br /> (,2' 'it lZ` `ik t1 cam: ccz-- $ ClGi <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ErNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ErYes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑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? ❑Yes CINo <br /> APPLICATION MUST BE SIGNED <br /> 545.112(aloe) <br /> (Continue on Back) ■ —to <br />