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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 /> -3 vi2 d �-2N►-' Scrt-I'S -► ❑ Zoning Status;CUP; <br /> OWNER-A7DDD7REC—(Number,Str t,City,State,Zip) Deed Restriction;CSM <br /> ` L J J 7"' ' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL DDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR_NAMES <br /> D. i tit I N t d� ecov fri.c 4' ❑ Site Plan including location <br /> AGENT ADDRESS C NTRACTOR ADDRESS of well/septic <br /> <--- taffy $Cy, K. ..ris`c1 <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> e /""Mify& tt.44- e L`--t <br /> PHONE PHONE ❑ Site Plan approval from <br /> C� 3 i,7_ E, '4157-2 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: RRENTZONI = ACREAGE: ❑ Elevation of property <br /> D PARCEL NUMBER " / f 9 ?/ i frontage drawn to scale. <br /> TOWNSHIP: SECTION: ❑ Driveway permits <br /> Ik 1.-4 A It 0 c 1i.: 30 Se �r h: N <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SU IVISION BLOCK/LOT ❑ Sanitary permits <br /> / Juew (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: �,� <br /> 5A14, i /3././i iiµ �` t3� : <br /> • LI This project is a new building or structure. { , , <br /> This project is an addition/alteration to an existing building or structure. -tip <br /> SANITARY SERVICE: PERMIT NUMBER: . :61003" <br /> ❑SEWER 1 SEPTIC ; t o <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) * � <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , <br /> BASEMENT: 1ST FLOOR: 9 ® a a <br /> Y4C Sy �� , TOTAL SQUARE FOOTAGE: ,, 1 2 �i .,1,,!� ` <br /> 2ND FLOOR: 3RD FLOOR: ��� <br /> :� � <br /> � .� Y <br /> ESTIMATED CONSTRUCTION COST: e$. — o a a. <br /> (Please round to nearest dollar) -p —► -► ♦ -+ -► � ?....0 0 t . t <br /> f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Cyr 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 a,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) Ii Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes XNo <br /> _` APPLICATION MUST BE SIGNED <br /> 545-112(4/08) )7116 ! <br /> (Continue on Back) -4. —► <br />