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ZONING PERMIT APPLICATION www•countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 6 � �r�� <br /> v / ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 5� <br /> SS 66 �}Y,/,I1( 27 !(/460th iv/ 35 Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHON E-M ADD SS /� �p <br /> 33y 666 tfl"t uV iV /eel`�-c' r ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> • <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: AC EAGE: P P rty <br /> ❑ NUMBER �,F'�'L - .5 W3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Qv)lae If -1/4: %I : ❑ Driveway permits <br /> V spy/ / Q state,county,town <br /> ADD 56� VI 2 spy hick) vl/ 533 0 ( ty town) <br /> CSM: ��� OT 1 SUBDIVISION / BLOCK/LOT ❑ Sanitary permits <br /> '0 67 I PC (public,private) <br /> PROPOSED PROJECT INFORMATION = "`§ <br /> - <br /> PROJECT DE CRIPTI•N: , , Cr', � <br /> .L. x r 1 <br /> • ❑This project is a new building or structure. g , ,r ^; <br /> Q This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: °tt .. <br /> ❑SEWER SEPTIC Y 1 A�i a ,;, " <br /> HEIGHT IN FEET: L NUMBER OF STdRIE (Not iincluding basement) � � <br /> a ; Jfr to Aa( e <br /> AREA TO NEAREST SQUARE FOOT: � ,,, -, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4 <br /> BASEMENT 1ST FLOOR: ® f*P <br /> 1V3030 4, TOTAL SQUARE FOOTAGE: ,, S _ ?i - <br /> 2ND FLOOR: 3RD FLOOR: ^ <br /> ESTIMATED CONSTRUCTION COST: = ® _ <br /> —� —► —I► -► ♦ -♦ <br /> (Please round to nearest dollar) $ 3 .: , - , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes cil No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? CEi Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ill Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? L3 Yes Li 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 I No ❑Don't know <br /> 7. Is this to correct a violation? cuYes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) !f (Continue on Back) ■ —► —► <br />