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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 /> oceNt k � P p4 ft ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zi <br /> 9 b If 3O GM oi•l /�s V e Deed Restriction;CSM <br /> �'I Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 73c, / i Al t7 y'4Lf " ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n <br /> AC, e f fj, G Alf/- LL+ C ❑ Site Plan including location <br /> AGENT ADDRES CONTRACTOR ADDRESS of well/septic <br /> )o 3 6 14iLt,CR La <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> ©Ike_g oti/ 41-11i . <br /> PHONE V PHONE ❑ Site Plan approval from <br /> '3 S- 77 oq 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 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> ' �" '/<'/: ME ❑ Driveway permits <br /> © r{� QA/a / 3 A: S <br /> ADDRESS: (state,county,town) <br /> 9 tot/ To L^{s ° ,J fl v c ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION �� <br /> PROJECT DESCRIPTION: x ' <br /> ❑This project is a new building or structure. a ,{ ,E-°,, <br /> I This project is an addition/alteration to an existing building or structure. �k <br /> SANITARY SERVICE: PERMIT NUMBER: t s:. k- <br /> ❑SEWER ®SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) , ' <br /> AREA TO NEAREST SQUARE FOOT: 1, . <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ° " � Ait " <br /> BASEMENT: 1ST FLOOR: <br /> ,.,'-'' ''.-F1.,,:,„,. .,,,..,,,,, <br /> , <br /> a 3 / p + TOTAL SQUARE FOOTAGE: + � �T ss s ,y <br /> 1 a <br /> 2ND FL 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: Q� <br /> (Please round to nearest dollar) " ' '� "� "� "� $ �© 0� oda c -fir <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'J No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 9 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 El 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 W No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes IiNo <br /> APPLI(Continue CATIO on N MUST Back) B—►E SIGNED <br /> 545-112(4/08) <br /> —► <br />