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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 /> ❑ Zoning Status;CUP; <br /> OWNER Ross (Number,Street,Ci t Zip) Of /, Deed Restriction;CSM <br /> ME PHONE SELL PHONE E-MAIL ADDRESS Variance(# ) <br /> 54//S ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT ME CONT CTOR NAME /� <br /> �� � L/i Q J / ❑ Site Plan including location <br /> AGENT ADDRE CONTRACTOR RESS of well/septic <br /> 01-V9 H " - /V <br /> (City,State,Zip) (City iyipee ip) �/ ❑ Setbacks <br /> PHONE PHOy� L:1 Site Plan approval from <br /> j��Q --- �� applicable township. <br /> E-MAIL ADDRESS E-M•IL ADDRESS G �a`� <br /> �.QA c J�'� t./l f / ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: AC E: LI Elevation of property <br /> PARCEL ER - 203- L4 152-• A- I C/3 4 g o.1b �� frontage drawn to scale. <br /> NUMB <br /> TOWNSHIP: SECTION: <br /> ,/4: ,/1/: ❑ Driveway permits <br /> ADDRESS: Tx , (state,county,town) <br /> 3?y <br /> ❑ Sanitary permits LOT 8:"..„2..... SuB f' ISIONS 4OCK/LOT (public,private)S /�L e r <br /> PROPOSED PROJECT INFORMATION '" ` <br /> PROJECT DESCRIPTION: r `4• <br /> ,��/ <br /> e a B a - <br /> • of is project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. : <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑SEWER LLSEPTIC =6I <br /> • HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) • .; <br /> Ss sy... rti' " i <br /> AREA TO NEAREST SQUARE FOOT: `. vY <br /> � f �" <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , ' ;, ® a <br /> BASE NT: �}, 1 ST F OAR: s- - I ei . <br /> b �,(n s , TOTAL SQUARE FOOTAGE: 1 , <br /> 2ND FLOOR: � ' 3RD FLOOR: - b"�',_ - <br /> s o <br /> ESTIMATED CONSTRUCTION COST 1/7.62Z a a�6 a.=_ 0e t <br /> (Please round to nearest dollar) ♦ ♦ ♦ . ' ♦ "♦ $ / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes LSNo LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Cam' 110 L3 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes U 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 [n lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yeso <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -4 <br /> 545-112(4/08) <br />