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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNERi.INFORMATION =. d= x <br /> OWNER NAME <br /> °w j CUSTOMER TO PROVIDE <br /> AJ //L /-/"a i< ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City.State,Zip) <br /> Deed Restriction;CSM <br /> ,-2 L .7( 5/j U6 f I G C J01//^(4))/SJ)td Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> "3C S 5 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR;INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co:danewi.usn <br /> Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> NUMBER /o8/i-3 2%-cciCZ-, ,2 f , j' 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION <br /> tt .J PO/ J<i 3 2-- 1A: ,5 G� 1/4 :7Ue ❑ Driveway permits <br /> ADDRESS: 0 (state,county,town) <br /> 026 7( 6/L,U6 /'/ -s 4,,,J /j/A-7/z ❑ Sanitary permits <br /> CSM: LOT z SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION: <br /> PROJECT DESCRIPTION: <br /> ❑This project is a new building or structure. [ <br /> 12.-1, <br /> This project is an addition/alteration to an existing building or structure. t r r <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> # :?. <br /> ❑SEWER �- SEPTIC �� X , C,� : <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ii:; <br /> AREA TO NEAREST SQUARE FOOT: n rt �. <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) # 5` `�--" <br /> BASEMENT: 1ST FLOOR: t c ® �` <br /> / 7, J X 9 U_ /7, 4, TOTAL SQUARE FOOTAGE: 4 <br /> 2ND FLOOR: 3RD FLOOR: © �� <br /> ESTIMATED CONSTRUCTION COST: , . 0 � GqaVkl <br /> ♦ ♦ ♦ ♦ ♦ —► .pt e reds <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 10No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes .glo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? A1'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1 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 X,No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yeslo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />