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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ���/gyp -T <br /> OWNER ADDR�ESS (Number, t,city,scatvziP y C4�O� "Zoning Status;CUP; <br /> �Z¢ �If40 , /4A/4 L ift ks 64,z* Variance Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,01-0(402— U'Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO TRACTOR NAME <br /> \Tl4/e1 P AAIZjr4►) ii..TA�//o4 1,/Lo€* ' at-site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 794? /W SW' I� <br /> (City,State,Zip) (City,State,Zip) L'J Setbacks <br /> /19/4.4RZ •/,G✓/ .Y-ggz- <br /> PHONE PHONE ❑ Site Plan approval from <br /> 69g—OS/-¢¢ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ....,_,e",y4.„,g,a`c"„ ,rp/ f, C Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 3-Elevation of property <br /> ❑ NUMBER O'708� (83-gtt�o-0 A/ Rh,-z_ I. 9¢,,, frontage drawn to scale. <br /> TOWNSHIP: SECTION: 4.- • <br /> r of fr ', 4 S tA-1 14: S U. 1/41A: 48 ❑ Driveway permits <br /> (state,county,town <br /> ADDRESS: c� ty town) <br /> / ,O `"��� Q'ganitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1/0; 3 AM (public,private) <br /> PROPOSED PROJECT INFORMATION —l(LL t '' <br /> PROJECT DESCRIPTION: '40444- <br /> . Rirs project is a new building or structre. <br /> A cgs : <br /> ❑This project is an addition/alteration to an existing building or structure. .. <br /> SANITARY SERVICE: „_.,� PERMIT NUMBER: '” t -- <br /> ❑SEWER SeS<TIC 5/7 4972■ _ <br /> HEIGHT IN FEET: off .boy NUMBER OF STORIES: (Not including basement) $"° <br /> AREA TO NEAREST SQUARE FOOT: ; <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,< <br /> ^ , ' s <br /> BASEMENT: 1ST FLOOR: •, � y <br /> Z SJ 3525- 4, TOTAL SQUARE FOOTAGE: 1 ®°:a to �= <br /> 2ND FLOOR: 3RD FL,O,.OwR: 60.5-760 ; - . <br /> /� / s Rai <br /> ESTIMATED CONSTRUCTION COST: -, - <br /> (Please round to nearest dollar) ♦ '♦ '♦ ♦ ♦ '* Z ' w� B 3!... "+r�4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ak o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Cis ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes C9'Ifo <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 ,Flo ❑Don't know <br /> 7. Is this to correct a violation? [-.] L Yes 1 <br /> /_ 0 <br /> G r V —.6 f f APPLICATION MUST BE SIGNED <br /> '""0 (Continue on Back) —► —► <br /> 545-112(4/08) _., <br /> r YO <br /> ,S.''0 , J% <br />