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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#• <br /> PROPERTY OWNER <br /> GILL.NER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER 0��1 -Zook 0 6 Z y <br /> QZoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> b ow 1)Acig RO. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS CC riI NL4,-- <br /> 10 20bg 772-3,41-0349 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ingl iientiell in 1442,CUSIOn Naffs' IXSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5 .— '15 u1 mq,U Sr' <br /> (City,State,Zip) (City,State,Zip) (14 Setbacks <br /> 5t 914\Qe,w,6 <br /> PHONE PHONE ❑ Site I from <br /> �_g 7_(,07 L applic�bre n hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> %Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usr7 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ NUMBER 07112.-n4-8660- 1 00 frontage drawn to scale. <br /> TOWNSHIP: �(,, 1^ SECTION: 1 �� <br /> nEW ti 1/4: I�Uj %1/4: t.Jf� A.DrivVs . p <br /> ADDRESS: (sta , •• ,4,420 <br /> Sanitary pe Ills /194- <br /> CSM: LOT SUBDIVISION BLOCK/LOT li <br /> (pu(public, •dr <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> ❑This project is a new building or structure. .- ' , �% <br /> XThis project is an addition/alteration to an existing building or structure. <br /> �= <br /> a <br /> SANITARY SERVICE: PERMIT NUMBER:. ' <br /> ti y <br /> ❑SEWER ❑SEPTIC ° , <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) .2t;g � �{ <br /> ,.v <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,; ` <br /> .$ASEMFNT: 1ST FLOOR: „ <br /> TOTAL SQUARE FOOTAGE: 4, ,' •' c . - ' <br /> 2(okls ,: <br /> 2ND FLOOR: 3RD FLOOR. a , <br /> -, .mot A <br /> , <br /> ESTIMATED CONSTRUCTION COST: co '.:"""0:46'. �_-,jf��"' <br /> (Please round to nearest dollar) "i "♦ ♦ ♦ ♦ --∎ $ 20, m x_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes g No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 4 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 X3 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 14No <br /> 7 g' ©0 APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -∎ -► <br /> 545-112(4/08) <br />