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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION:: ti , - . CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 6,r6/1G/70.0 ,% 2 'i%'5 LGG ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> iv G 4-T4-- �j'j`Eu'A/2T 2/7 W jw'T-7-T to 5 3 ' Variance(# ) <br /> HOME PHONE /�� CELL PHONE E-MAIL ADDRESS <br /> 6. 3 4 ' 6 T it 5-3 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 2,c,Ng2p ®( 1-1�4' r 9400 ❑ Site Plan including location <br /> AG NT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 6 C Q— 5'70tiliter RP . <br /> (City,State,Zip) (City,State,Zip) LI Setbacks <br /> Pe ylv777'1E wt 3'f�`i <br /> PHONE PHONE - ❑ Site Plan approval from <br /> 6 35- 4-4‘q- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: u ACREAGE: P P y <br /> ❑ PARCEL " jZ1y� frontage drawn to scale. <br /> NUMBER oci/o-z 12'Soscp-o 6 2 <br /> TOWNSHIP: SECTION: <br /> llv o2 wl5 ,/: ,/,/. LI Driveway permits <br /> ADDRESS: (state,county,town) <br /> £'7 D b ektir —Cr, ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> I 5 - (public,private) <br /> PROPOSED PROJECT INFORMATION - ;, ' <br /> Pöl1/Zl7lft16—JECT DESCRIPTION: 'PA � <br /> 13v��i 5 -10 w T e , ._ <br /> . <br /> This project is a new building or structure. nV.; F ,y '- <br /> LI This project is an addition/alteration to an existing building or structure. <br /> ;ci <br /> SANITARY SERVICE: PERMIT NUMBER: a °D � <br /> PalEWER 0 SEPTIC illlii-AtOr: ,!JO,V "" <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ,'-":=101,00 0V <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) z `' - ' <br /> BASEMENT: 1ST FLOOR: ® .. , o <br /> 7 j, TOTAL SQUARE FOOTAGE: j e �e �a <br /> sr :11-a <br /> 2ND FLOOR: 3RD FLOOR "� a ' <br /> 2 C .go ,�.' `,," .�� .. - 4 -if, <br /> ESTIMATED CONSTRUCTION COST: �Q � , <� <br /> (Please round to nearest dollar) ♦ ♦ -* ♦ --► "♦ �- f 4, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 23 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes N No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes El 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes A No <br /> e..M,tT -- �•` r>n <br /> p APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —I• —► —► <br />