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!1-z-y1 , <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION- CUSTOMER TO PROVIDE <br /> OW ER NAME C <br /> t'L 2 t 6-S I1 J ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) g ' ' <br /> (o I j. '4 L O ''"l�`-1-55/2-S 2 ` Deed Restriction;CSM <br /> {�V Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 7E 1- 33f! aL NJ A��c►ton.�s Ca"' ❑ 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:/laccessdane.co.danewi.us/) <br /> PARENT PARCEL NUMBER: RRENT ZONING: <br /> ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL o$a7-Os3"730 j-r 4 frontage drawn to scale. <br /> NUMBER <br /> TOP: SECTION: <br /> e.-JX- '/ <br /> S 14 1/: S V ❑ Driveway permits <br /> state,county,t <br /> ADDRESS: ( ty' own) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> C. 13 (public,private) <br /> PROPOSED PROJECT INFORMATION <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. z _ <br /> SANITARY SERVICE: PERMIT NUMBER: m 4:14:41K,1. <br /> 7 <br /> � <br /> ❑SEWER SEPTIC �.- L / ' a <br /> Co <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) zr <br /> BASEMENT: 1ST FLOOR: M ®� _�qrk€ ` . <br /> TOTAL SQUARE FOOTAGE: ,�, j` q 4� � <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1a* aszng say <br /> ESTIMATED CONSTRUCTION COST: Q� a a r g lr t � <br /> (Please round to nearest dollar) '� O ��� Y - x , - <br /> _ t> <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 ❑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 Q No <br /> 5. Is this project associated with'a're�bne/CUP/variance(petition/appeal# `;),': ,cleave blank if none) ., .. . , <br /> ❑ <br /> 6. Is a location survey required? (see reverse) Yes ❑No 0 Don't1know <br /> 7. Is this to correct a violation? •❑,Yes ..❑Ncr r -. <br /> w O <br /> APPLICATION MUST BE SIGNED <br /> 545112(aoe) <br /> 0/641 (Continue on Back) -► -i -► <br />