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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE NAME <br /> V,f`+— , Q J Q t C (/\ <br /> O R ADDRESS (Number,Street,City State,Zip)) oning Status; CUP; <br /> ti <br /> f c Deed Restriction; CSM . <br /> -7-0 2.✓'C Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> •O'6- '7 3 4100 6 Sit n drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan_jpeitreling location <br /> AGENT ADDRESS CONTRACTOR ADDRESS . • <br /> � n`aC <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> PHONE PHONE ❑Site P n a oval from <br /> applic wnship. <br /> E-MAILADDRESS E-MAILADDRESS <br /> Fl r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us0 Ele tion of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE ...... P P y <br /> ❑NUMBER Q So/0c 0 ' 7 Q4 ( — / o .. ntage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 0 r \ 1/4: 1/41/4: El <br /> permits <br /> ADDRESS: <br /> (St , unty,town) <br /> J- - �Ve VC/NI ❑San' _i •-rmits <br /> C S M�� LOT SUBDIVISION BLOCK/LOT / ir vate) <br /> PROPOSED PROJECT INFORMATION F REVIEW <br /> P OJECT DESCRIPTION: <br /> I Q x (1' Q./Zoning District <br /> . tis project is a new building or structure. C3 'ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMB/E,R: }-,r�'�� IN Rural Address <br /> HEIGHT IN FEE EWER is TIC NUMBER OF ST RTES: (Not including basement) (n Stin <br /> • e,:•. !.:.Gain/ <br /> Shor- ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ® Et• OnCO Ol permit <br /> I / `) j TOTAL SQUARE FOOTAGE: +, (slop- , turbance, <br /> filling!-« - ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> I 0 1! Re ' Lo on Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ LSC)C and avai option( d dll ) l <br /> i1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes ❑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 EN ❑Don't know <br /> 7. Is this to correct a violation? Lives EN <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -i -∎ <br /> 545-112(4/08) <br />