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• <br /> - ZONING PERMIT APPLICATION www.countyotdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER N <br /> l�/6/NAL s Er ill S NkL-'Fl Zonin Status;CUP; ' t ( <br /> OWNER ADDRESS (Number,Street,Ci ,State,Zip) Dee g <br /> 78(260 L/0O45 L I d Restriction;CSM f <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> if ��p <br /> BOOB '633-3i''3 .o g- yy -tf(�)-z M S ,i,a i C Ti S i /YI1 pA Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION -nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 6Z L #'d Site P -• '• •'•• location <br /> AGENT ADDRESS CONTRACTOR ADDRESS . septi <br /> i <br /> (City,State,Zip) (City,State,Zip) 40 Setbacks•PHONE PHONE ' = -••roval from <br /> applicable township. /• <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> to Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1F�Elevation of property <br /> PARENT PARCEL NUMBER: 9 CU ENT ZONING: ACREAGE: ,) p P rty <br /> NUMBER 6705-�)9 -(o2(O� - t . •9 I frontage drawn to scale. <br /> TOWNSHIP: ECT N: <br /> AA/DhLk i oN . 4: SEs(4 %%: ►'4 Driveway permit <br /> ADDRE 8 / (state,county own) <br /> �o C ' 05 5 (7— <br /> Sanitary•- mils <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public ar <br /> Nloe I INk, I <br /> PROPOSED PROJECT INFORMATION <br /> 3 .r i ' ' f l 1 <br /> PROJECT DESCRIPTION: ' l 7 F r <br /> G a <br /> ❑This project is a new building or structure. Cl <br /> / �(/ <br /> This project is an addition/alteration to an existing building or structure. ,- ,° y r ,� x �1, <br /> SANITARY SERVICE: �$9 e a d x - r ' <br /> PERMIT NUMBER: � � .�$,� <br /> ❑SEWER (SEPTIC s' ,'� a6 °�4 <br /> HEIGHT IN FEET: / ( NUMBER OF STORIES: (Not incncluding basement) <br /> G <br /> ii::: 2::::----:!! :--- - ''''''~ '- -,' k <br /> AREA TO NEAREST SQUARE FOOT: • <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) f ' ` � / <br /> BASEMENT: 1ST FLOOR: £, + � � ��� � ��� / <br /> /// <br /> S--? C ,, TOTAL SQUARE FOOTAGE: 4, , • •E I I <br /> 2ND FLOOR: 3RD FLOOR: �� • a s ��, <br /> ( r°° <br /> ESTIMATED CONSTRUCTION COST: • ®(@- t�� <br /> (Please round to nearest dollar) "'* "♦ ♦ "♦ ♦ ♦ O <br /> ► l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes • ■o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes it • o ❑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 No \ �� �r t , <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) V- k��1J <br /> 6. Is a location survey required? (see reverse) ❑Yes to ❑Don't know J <br /> 7. Is this to correct a violation? ❑Yes po <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545-112(4/09) <br />