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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App U <br /> PROPERTY OWNER INFORMATION :774 g P <br /> OWNER NAME <br /> ,,,r. R L <br /> OWNERADDRESS (Number,Street,City,State,Zip) <br /> PHONE E-MAIL ADDRESS <br /> 8�i5-�0 9 ' ee 75�SOl�fds• i f- * <br /> AGENT INFORMATION CONTRACTOR INFORMATION i �„� �, <br /> AGENT NAME CONTRACTOR NAME t <br /> AGENT ADDRESS <br /> CONTRACTORADDRESS i <br /> td fv : i�'.” '. ff €m R <br /> (City,State,Zip) <br /> r� ,, t - <br /> ( Y, P) (City State,Zip) `1 <br /> PHONE PHONE <br /> tE� I , <br /> E MAIL ADDRESS E-MAIL ADDRESS '' <br /> PROPERTY/LOCATION INFORMATION (http:!/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: q x $ . <br /> ❑ PARCEL o��'o oZ"OS 9 p1'` / / a a� ',', <br /> NUMBER � �' /V" RH-I �" , � <br /> TOWNSHIP: SECTIO x: as <, �.< <br /> r� A ' - 3v,E Y4 ADDRESS: � / ,, r, � ` -, <br /> 7 o I,n f'I�t44Ow �ou� 1 <br /> 450 � I ,Pr �. = `. �� � ( '��:��� 0 <br /> CSM: _��_��' IT <br /> SUBDIVISION BLOCKAOT +> <br /> —�. f' Wil*.77--e%- ,,,t.; <br /> PROPOSED PROJECT INFORMATION I - ..« M< ° ' ��� <br /> PROJECTT�D{ESCRIPTION: y� '; <br /> This project is a new building or structure. % 4 <br /> • Li This project is an additio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> SEWER EPTIC '� 14I ,• t der <br /> ` L� ,? <br /> HEIGHT IN FEET <br /> NUMBER OF STIR TES: (Not including basement) <br /> S'6 ,t€ t. *4 e n <br /> AREA TO NEAREST SQUARE FOOT: �$;; � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT. 1 ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE ? �' l.; <br /> H <br /> 2ND FLOOR: 3RD FLOOR: /� ,v <br /> 1 <br /> ESTIMATED CONSTRUCTION COST: �l 3, <br /> -► -� -1 -� -► T . ; € , . <br /> (Please round to nearest dollar) ��.Q V , 1:4, ,. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes �No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes <br /> lo ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes ❑ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Ye No <br /> 5. This project is associated with arezone/CUP/variance(petition/appeal# ) (le blank if none) <br /> 4 11. ' <br /> 6. Is a location survey required? ❑No ❑Don't know <br /> 7. Is this correcting a violation? Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -■ -♦ <br /> 545-112(1/08) <br />