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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNS NAME yD ,,�/ /�J <br /> hMW�• ' t'Z/ '� �^�' 4 ' / 4't ❑ Zoning Status;CUP; <br /> OWNER DRESS (Number,Stre Cityy State Zip) /� Y Deed Restriction;CSM <br /> HOME PHONE � CELL � � E-MAIL /O��,v� 53'4'2. Variance(#_.69p____) <br /> lo�'-S�� Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ef. e661 /fSiN J AvoT/ Cdi . c• ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS I of well/septic <br /> 2166 aefizez, J,de J7G� a�ai44J € <br /> (Ci State,Zip) (City,State,Zip) Setbacks <br /> /"/?z l.L,eli, k) 0:57// f red-W.44. /dZ 5371 CI Site Plana royal from <br /> PHPNE HONE ,� pp <br /> (vOf 73.3 9 6of- t7 -d3of applicable township. <br /> E-MAIL ADDRESS / E-MAIL4.DDRESS <br /> Q G�jq^Te/. �(',7__ ' 6 a Mize-mg ./tie-7—./t/ET ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL �yJ j "�r���� /�� frontage drawn to scale. <br /> NUMBER '44 ! C <br /> TOWNSHIP: SECTION: <br /> ❑ Driveway permits• OP iortoQ 7 d S /: S- . l % : /J / <br /> ADDRESS: (state,county,town) <br /> ✓o/ /C ' "P? �4 <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> eanof /3 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF RE W <br /> PROJ TDESCRIPTION: 7 'Y:iiri. <br /> • CI This project is a new building or structure. 3 is <br /> ❑This project is an addition/alteration to an existing building or structure. '' <br /> SANITARY SERVICE: PERMIT NUMBER: et:I Ad+ress <br /> ❑SEWER ❑SEPTIC new/exist) e <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> / v--�e gy3 <br /> nt) , <br /> AREA TO NEAREST SQUARE FOOT: r =V1- f <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � 7 <br /> BASEMENT: 1ST FLOOR: rosin 1COt1 O � � <br /> 4, TOTAL SQUARE FOOTAGE: 4, x .I ancel, <br /> 2ND FLOOR: 3RD FLOOR: 41-.. . .0* - . <br /> 2 D g <br /> vl 4. <br /> ESTIMATED CONSTRUCTION COST: Ac., p .4ava . .�� <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? 0Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? CI ❑No CI <br /> 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 >1W ❑Don't know <br /> yr7. Is this to correct a violation? ❑YesNo <br /> — I/0 X D'0 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -* -♦ <br /> /8 <br /> (O <br />