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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 /> E'(J c.T tE/1 � ❑Zoning Status;CUP; <br /> OWNERADDR- S (Number,Street,C `S e,Zip) �- <br /> `� 6 T`! 6t w �vn c-For e A Deed Restriction;CSM <br /> s G!- ` l( Ks c�� � .SS Variance(# ) <br /> HOME PHONE CELL-HONE E-MAIL ADDRESS <br /> o$ 7 -- .26 var 0 d . gt_ 0• ' 9.f / Co ❑Site Plan drawn to scale <br /> AGENT INFORMATION 'CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTR TOR NAM <br /> E..--7 (.,Qckf ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS r of well/septic <br /> Zl� r S 6+/ �nn RI- <br /> (City,State,Zip) (City,qlpty,Zip)A ❑Setbacks <br /> adrrson VI •S?7/C <br /> PHONE PH j ❑Site Plan approval from <br /> ( 6O0 7.37r.....2hYs.3 applicable township. <br /> E-MAIL ADDRESS E- • LAD9RESS <br /> Tea P (Ike-h II a 4 . C6N1 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co-dane.wi.usI) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. . <br /> NUMBER <br /> TOWNSHIP. SECTION: <br /> Li 1/4; 1/1/: ❑Driveway permits <br /> ADDRESS: /h ,�/ (state,county,town) <br /> cs.,76.3 �t L4 Go, F�`susD/v SUBDIVISION cl BLOCK/LOT <br /> or ��5�8 E]Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ,, '171'171-1777717.,.#7.,V <br /> PROJECT DESCRIPTION: ' , y ' <br /> L I• Ar 4 ~ j ■ _ ii LA I •' 44/ cif 3 � � E w <br /> This project is a new bu Iding or structure. 1 M,. .' i; 1 � `t� <br /> ❑This project is an addition/alteration to an existing building or structure. , ; . , e `1 u <br /> SANITARY SERVICE: '' '4444 g. <br /> PERMIT NUMBER: � � f� <br /> $ rvt� <br /> EWER E)EPTIC kY " ".•Ffi'5� W- , <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) x ' k 9•11.,,,,..,?.2.7L-2,... <br /> AREA TO NEAREST SQUARE FOOT: .4 l tl l t� , :t1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ;,tom ' �,' :. r. <br /> BASEMENT: 1ST FLOOR. rF , y <br /> f4 - f�F <br /> TOTAL SQUARE FOOTAGE: j t 1 . <br /> r <br /> 2ND FLOOR: 3RD FLOOR: 2 98 go4iit i ,i re . <br /> ESTIMATED CONSTRUCTION COST: 1', { _ 1. i r; :. <br /> (Please round to nearest dollar) '� '� "r ,Z �QQ ` .`11 it 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Ries ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes ENo ['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? rgYes ❑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 • o ,Don't know <br /> 7. Is this to correct a violation? ❑Yes ►∎4 o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -o -4 <br /> 545-112(4108) <br />