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• <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.conl SUPPLEMENT to Web•App# <br /> PROPERTY OWNER'.INFORMATION � _'1:=-1. . 14',,3 = ': ` - '' CU'TOMER TO PROVIDE <br /> OWNER NAME <br /> J 0.y E k- - a Zoning Status;CUP; <br /> OWN RADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> A3oy /' T�^ AIR (-4.4f f/1,1- cs 3�a. ariance(# ) <br /> HOME PHONE CELL PHONE E-MPILADDRESS <br /> cie Y 6--e,33 •1 m 46 ,ale i'l-e—,j 6c),Co, a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> G 1a,;rt./ Sit Plan including location <br /> AGENT ADDRESS C ift>1 , , e CONTRACTOR ADDRESS o well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ Site PI revatfrom <br /> t0 Al plicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wims/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P y <br /> ❑ PARCEL <br /> NUMBER 0615i0? —t *$,9-0-42 A^ I E \ / frontage drawn to scale. <br /> TOWNSHIP: SECTION: L' / vewa <br /> • <br /> f. <br /> y permits 1 N ®� , , :/ _ /� �C/ -te,county,tow n) <br /> n)ADDRESS: </3 0 ��wl 1 (`• <br /> ❑ San' ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT ublic,private) <br /> 70/( <br /> PROPOSED PROJECT INFORMATION TA F �; <br /> PROJECT DESCRIPTION: ° xi <br /> L s project is a new building or structure. , #2 �-' <br /> ❑This project is an addition/alteration to an existing building or structure. 41 ,'� r _F <br /> SANITARY SERVICE: , PERMIT NUMBER: l e a a;'C �, g <br /> ❑SEWER tom-SEPTIC -C <br /> HEIGHT IN FEET: i� NUMBER OF STORIES: (Not including basement) ;� �Z ,�'> <br /> �°y"r -,: rta y, n <br /> a E ,� <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porchesc "' <br /> BASEMENT: 1ST FLOOR: +� ?� e t � e <br /> IO 4, TOTAL SQUARE FOOTAGE: a� aE a it <br /> cif '"� ,�L.�' � <br /> 2ND FLOOR: 3RD FLOOR: /0 a �7 , t <br /> ESTIMATED CONSTRUCTION COST: R n 0 �� <br /> (Please round to nearest dollar) "� "s "� $ p� -r ®rte�e N <br /> 1 �. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes L�,N/o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI U Yes No ❑Don't 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? LI Yes Ld'No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le ve blank if none) <br /> 6. Is a location survey required? (see reverse) Yes i❑ oo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes l..f'No <br /> / q _ , APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► —► <br />