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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE NAME ('t hc J �I <br /> oning Status;CUP; <br /> OWNER ADDRESS (Number,Stre City, <br /> State,Zip) Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG T NAME CONTRACTOR NAME <br /> e'/c (1 hJe/ ❑Site Plan including location <br /> A ENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City, at ,Zip) (City,State,Zip) S CI(S <br /> VN, E]Site n proval from <br /> PHONE <br /> PHONE <br /> C) 7 )- n S appli a township. <br /> E-MAILAD9S E-MAIL ADDRESS <br /> t 'e,,ti,t�i` n .00 oor plans to scale <br /> PROPERTY/LOCATI ON INFORMATION (http://accessdane.co.dane.wi.us/) Vation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER • // } / y�9 c ._ frontage drawn to scale.■ <br /> TOWNSHIP: SECTION: <br /> P S 1/4: 1/41/4: Driv y p its <br /> ADDRL$,S; (state nty,town) <br /> \,,,,..t u�, r' Sani a rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT tro V (�`F ! (p lc, rivate) <br /> it <br /> PROPOSED PROJECT INFORMATION ,A °.STAFF REVI <br /> PROJECT DESCRIPTION: <br /> Ing C tFI,Ct 'l, : <br /> �S o•4 ►`� Y`' 70-er � �� ,u. G, <br /> • ❑This project is a new building or structure. , Use? <br /> ,21Zhis project is an addition/alteration to an existing building or structure. <br /> C� �turalA•®. <br /> SANITARY SERVICE: PERMIT NUMBER: r �'� '' <br /> EWER SEPTIC �n T a <br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not including basement) ,I °: <br /> j.7-f s Y 1 f M®la qz. <br /> `"o <br /> c• c • �t <br /> AREA TO NEAREST SQUARE FOOT: , ` ti � <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) " <br /> BASEMENT: 1ST FLOOR: , d s } } :� <br /> k <br /> - L 1 I 0 GS + TOTAL SQUARE FOOTAGE: 1 '' •� > <br /> I't ,,r- - - -- <br /> 2ND FLOOR: 3RD FLOOR: / � <br /> i� e. m` <br /> I � � � �� '�tSCatic�n SUrY <br /> ESTIMATED CONSTRUCTION COST: �� � <br /> (Please round to nearest dollar) <br /> Y V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EN ❑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? [Yes ❑No <br /> 4 Has there been a zoning permit issued for this property in the past 5 years? 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? EYes EN <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />