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` ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAM CUSTOMER TO PROVIDE <br /> • I •l� (su !' oning Statu-,C ADDRESS (Number,Street, ty,Stp) n \ - , <br /> de4a,b • 1 ME PHONE CELL PHONE Variance(#r s <br /> G, E- AIL AD ,E�SSSI p <br /> OA;-I 1-)0 i_ v Z�Y�fl.'t� • 4►'i Site Plan d :scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> `74 Site - -• '.-- sing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of -ptic <br /> / / <br /> (City,State,Zip) (City,State,Zip) %Setbacks L 2"/ 3 0 _5 0 <br /> PHONE PHONE <br /> ❑ Site Plij ... . al from <br /> appll•p• =t• / . ip. / <br /> E-MAIL ADDRESS E-MAIL ADDRESS ^ ^��� <br /> XFloor plans to scale v// <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property �� <br /> f�'NUM ER 0458 [�B 1I -33y-1 '00-0 124-1 2, fronts a drawn to scale. <br /> TOWNSHIP: / SECT O <br /> ADDRESS: <br /> ` `J 3 1 lil�lllllk /✓ -1: 5c 1�41�a:,J E iA Dr' 4,i,= mit <br /> Lt ak0 es� A0c\ ( .. own <br /> c.C LOT SUBDIVISION �Se ��'' oils <br /> ((��, BLOCK/LOT <br /> • "1 1 a (pu.lic i a, <br /> PROPOSED PROJECT INFORMATION <br /> -: i <br /> PROJECT DESCRIPTION: ^2 �}CL ' �L <br /> € � � a IIE V - <br /> • Et This project is a new building or structure. - � � <br /> @ # # 3 <br /> ❑This project is an addition/alteration to an existing building or str ct re. „ <br /> SANITARY SERVICE: PERMIT NUMBER: . <br /> ❑SEWER SEPTIC 1:1°F/14t $ <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ,.. x <br /> - 9 0 ♦ PS @ : <br /> A , <br /> AREA TO NEAREST SQUARE FOOT: $. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: <br /> r14,,,T0 -2tY1,":41Aragaet... <br /> `� �' <br /> 1ST FLOOR: J .!:".„4„,., Q 0 . o- <br /> / O 4, TOTAL SQUARE FOOTAGE: ,, S @ a m. �:L <br /> 2ND q .. , 1 ..Mgr <br /> ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ ♦ -► --► -► -► o O 4• - • .t�@ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes L1 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? gYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [,a 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 A.No ❑Don't know <br /> 7. Is this to correct a violation? Li Yes XNo <br /> 0 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> / I D (Continue on Back) -o• ♦ -► <br />