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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 /> h`n.✓A i D 0' x)C L50 )i ❑ Zoning Stat • UP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) Dee riction;CSM <br /> 75) AL/C.,C 0i q riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6 V 3-4773 --Site 'Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a,• includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> r Site PI Ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS a I/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 /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usnevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONI : - : ' -E: c/ P P rty <br /> ❑ NUMBER C)�II-'1?/�a3 - -o O'L I W • L Co 3 frontage drawn to scale. <br /> TOWNSHIP: <br /> l�L�,IS-4 SPle1A S sE oK . 4: Iv.8..... %/4: xi ❑ Drive ermits <br /> �C e,county,town) <br /> ADDRESS: ` A■ l C e_ C P <br /> C/ \J -f>k 5 J ❑ Sanitary per its <br /> CSM: LOT Va AUBDIVISION BLe. OT <br /> Y n_fPs_ q S i ' r (Publ' Nate) <br /> PROPOSED PROJECT INFORMATION lec 1 (� -.157:il <br /> PROJECT DESCRIPTION: - ,°< <br /> ❑This project is a new building or structure. $ , = „ <br /> ❑This project is an addition/alteration to an existing building or structure. �- �, y� � , <br /> SANITARY SERVICE: e ai _ ' -NUMBER: p � �' �� <br /> SEWER ❑SEPTIC -- . . F � <br /> z <br /> HEIGHT IN FEET: If r NUMBER OF STORrS: (Not including basement) - <br /> °, A B-" �,&P'-i Imo!t <br /> AREA TO NEAREST SQUARE FOOT: :? r .4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - �.. <br /> BASEMENT: 1ST FLOOR: (■ (� + <br /> 1Y. 4, TOTAL SQUARE FOOTAGE: j o- . .,,". �, <br /> l �-+ t <br /> 2ND FLOOR: 3RD FLOOR: v � < <br /> ESTIMATED CONSTRUCTION COST: r . l - <br /> (Please round to nearest dollar) "∎ ""∎ "∎ "� $ q/ f'7 3, g g f ,, <br /> , V _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ,Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑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 7 N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No 14 Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> ,- <br /> APPLICATION MUST BE SIGNED <br /> < (Continue on Back) ■ —► <br /> 545-112(4/08) <br />