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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 /> —\ U O b w■no�( pr4 Zoning Status;CUP; R- 2- <br /> OWNEfiA RES$ (Number,Spree ty, ip), ���� t ��� <br /> �/�',1`('�l `nj 1 �`iMy f" Deed Restriction;CSM <br /> `� Variance(# ) <br /> LIH ME PHONE CELL PHON E-MAIL ADDRESS <br /> 3 .-oS 226 002 =i Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S 44-Wkil i.-,S 61A) V\-6"1/ LKSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> r <br /> PHONE PHONE Site Plan approval from/ 4_ <br /> applicable township. f{�� 1r� <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /g Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBEg,, CURRENT ZONING: ACREAGE: A Elevation of property <br /> 0 PARCEL /2Q)I <br /> NUMBER �l b — Z frontage drawn to scale. <br /> TOW IP-:. ,,/ SECTION. Ai A <br /> ��l 11..V'Ll�-. t -1/4:OW ,/,/:S� ��4 D ' - ay permits <br /> ADDRVIV t ' k, kA (s ate county,town) <br /> CSM: �C Lo 0'--4 Sanitary•- <br /> f '� ^ SUBDIVISION BLOCK/LOT � <br /> ■ ' 51 % 1 (pub!' ,private) "1 <br /> PROPOSED PROJECT INFORMATION _ -r rw *Y <br /> PR• T_DESCRIPTION' <br /> n `C- . <br /> ■ <br /> V , <br /> �� This project is a new building or structure. y- b "` Z- <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: k <br /> FY lvIL+e PERMIT NUMBER: s s <br /> ❑SEWER SEPTIC s a <br /> HEIGHT IN FEET:q 1 5 NUMBER OF STORIES: (Not including basement) f',4tiit4-- " <br /> '� a: sssa <br /> s e ,.ter s B <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade dicks or porches) ,q :� <br /> BASEMEN 01 s I® U ® • h <br /> 1STF O R: ,,,: f <br /> -- � 8� 4, TOTAL SQUARE FOOTAGE: J. s° al _ <br /> 2ND FLOOR: 3RD FLOOR: : �� <br /> ESTIMATED CONSTRUCTION COST $ 50-1G. / ^ I ^- <br /> Please round to nearest dollar) -4► ♦ -4. -+ ♦ "� UC I a ®°e '/VCS <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yeso ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? CI Yes 'No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes tit/No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (I ave blank if none) <br /> 6. Is a location survey required? (see reverse) JOI Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► <br />