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ZONING PERMIT APPLICATION www.countyofdane.com suPPLEMENT Web-App p <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM,B., i vq n t e _S fra�i oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,C ,State,Zip) <br /> 6Q j Yt-2, i s a U� G'�� s U Deed Restriction; CSM <br /> Y <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ?(• -6 1 ' 606 919"09(°L an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> El <br /> a la ncluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS eptic <br /> City,State,Zip) (City,State,Zip) acks <br /> PHONE PHONE ❑ Site P n a royal from <br /> appli etownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Flo ans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJlaccessdane.co.dane.wi.usn Ele ion of property <br /> PARENT PARCEL NUMBER: CUR NT ZONING: ACREAGE: p p y <br /> ❑PARCEL c / r\ �� ro ntage drawn to scale. <br /> NUMBER 0-7 10 4--.�4�'i S'] - — 1 J <br /> TOWNSHIP: / SECTION: <br /> �(O /4,tcn9 70 ve <br /> .1/4. <br /> .1/4.1/4: n Drivew y p mits <br /> ADpRESS: (state unty,town) <br /> GCS me 1S czv-z r'1Gcd/ 5pyt w1 <br /> CSM: LOT SUBDIVISION BLOCK/L.T ❑Sanitary .ermits <br /> 5 a ) (publi• private) <br /> PROPOSED PROJECT INFORMATION ST FP REVIEW <br /> PROJECT DESCRIPTION: <br /> .Q� ' i O >-.). )-- Wing District <br /> . ❑This project is a new building or structure. P mined Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: <br /> �EPTIC PERMIT NUMBER: ral Address <br /> EWER ta (new/>-sting)1 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ■ ' <br /> etla •.odplain/ <br /> S : eland_. :ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> Ion..• rol permit <br /> BASEMENT: 1ST Fl,CZOR�0 4, TOTAL SQUARE FOOTAGE: 4, (slope., dis rbance, <br /> c\� ♦ fil' g/access <br /> 2ND FLOOR: 3RD FLOOR: �� � � <br /> GI Review Location Survey <br /> ESTIMATED <br /> CONSTRUCTION COST: and mailable options. <br /> (Please round o nearest dollar) -► —10. ♦ $ '5 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lives ac❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ©Z <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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545-112(4/08) <br />