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1 <br /> , <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,�dr I / <br /> OWNER A66Rs ('Numb(sec cVs-te z P _ ❑ Zoning Status;CUP; <br /> I 7 p Z 5V-01.(1141.#), Deed Restriction;CSM <br /> © 'k A l2 W I - Variance(# ) <br /> HOME PHONE CELL PHONE E- AIL ADDRESS <br /> 877-0i 20 rl3-4/r32- <br /> 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> p/ ✓SC Nm vl.W x1 G- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> `/2Y" l717v &.? - <br /> (City,State,Zip) (City,State,Zip) l ❑ Setbacks <br /> eihn c /yzkr1yik-e/6./i S 3J-1-a' <br /> PHONE PHONE r ❑ Site Plan approval from <br /> (.,,;p y3 Y-&d}'0 &a 6,2-e-1/67 Cj applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL D‘//- 3 frontage drawn to scale. <br /> NUMBER !! ��"�� 7�-y <br /> TOWNSHIP: SECTION: <br /> 66. 3 y 1/<: S 1/1/.: , ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> /7 a 2- 2a 6*,< 42 Srdr.,y i fr,, w i,_ <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: `' ;. <br /> ❑This project is a new building or structure. �a ;,` ' <br /> This project is an addition/alteration to an existing building or structure. <br /> � ' <br /> SANITARY SERVICE: PERMIT NUMBER: , ` � ,-®s 4� � �� <br /> ❑SEWER SEPTIC ;''€ k F ,, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �q k <br /> 8 9 3 <br /> i8 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ti N kz, <br /> BASEMENT: 1ST FLOOR: <br /> .® z: N <br /> 2 s Z 2 S ,, TOTAL SQUARE FOOTAGE: , <br /> 2ND FLOOR: 3RD FLOOR: ''O ® 'a , <br /> ESTIMATED CONSTRUCTION COST: , '_ A,e i <br /> (Please round to nearest dollar) ♦ ♦ ♦ "� 6 „ <br /> ,rrd <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes a No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Q No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? lia Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI Yes ONo <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 4 Don't know <br /> 7. Is this to correct a violation? ❑Yes .I No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 5� (Continue on Back) ♦ —►OD <br />