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ZONING PERMIT APPLICATION www.countyofdane.com .SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION ,;: . . ';-tom'«';,: ; ,',.. - '• CUSTOMER TO PROVIDE <br /> owNm <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS Number,Street,City,State,Zip) <br /> �- Deed Restriction;CSM <br /> 727,5 , 1-1-.'t/ Q r- /1-(-1-e-€ .--,, kir j i71 8' Variance(# ) <br /> HOME PHONE CELL PHONE 2 E-MAIL ADDRESS <br /> ! <br /> D / . — o2% NrSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION .. and includes dimensions <br /> ANT NAM C CTQR)...914 <br /> '� 4� f�e-%s Site Plan including location <br /> AGENT AD RESS aN9TRACTOR DRES of well/septic <br /> (City,State,Zip) (City,State, p) , a Setbacks <br /> 1'2a ° to ' • ,S,32(3.- <br /> PHONE -HONE 1*Site Plan approval from <br /> 4 77- .3 ' applicable township: <br /> E-MAILADDRESS E-MAIL DDRESS <br /> Pr Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn rkgr,Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> W NUMBER CS ?`° `0f'8ia`0 A- 2 ` l) I h c frontage drawn to scale. <br /> T WNSHIP: 5 ION' <br /> ). ✓ (J ,/: /5 1/,/: ❑ Driveway permits <br /> AD/Rs�s:/� /� (state,county,town) <br /> C'l `U C-v -,e, (h.i. Er Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> /1.7a — (public,private) <br /> PROPOSED PROJECT INFORMATION. : y <br /> PROJECT DESCRIPTION: yew : ' <br /> c4:0T/ Y1 '"' , 4 <br /> • This project is a new building or structure. ;-f( �, t , r a � x• <br /> ❑This project is an addition/alteration to an existing building or structure. ; <br /> SANITARY SERVICE: PERMIT NUMBER: ������"�-�°gt�i`�. � � � <br /> + i _ <br /> ❑SEWER SEPTIC �7 7 , 7 C. aA• 8 i i �-° � <br /> HEIGHT IN FEET NUMBER�OF STORIES: (Not including basement) y ray_ <br /> ms` '^3 <br /> AREA TO NEAREST SQUARE FOOT: € - "1".-;.!'Y° <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 1 ',. <br /> BASEMENT 1ST FLOOR: t° o, i - <br /> C)d ?C5 d F° +, TOTAL SQUARE FOOTAGE: ,, ---1 F a�RX ,rr <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: 56 0(10 r � . ,t� <br /> (Please round to nearest dollar) "� � �t j�Q . C� � � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes J 'No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 64No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes 121No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI Yes EiNo <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) LI Yes IX No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aios) (Continue on Back) -► -0. -0 <br />