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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 /> , �� <br /> t' �� �rf/y,9' AeZoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City, tate,Zip) 7 / ,'/ Deed Restriction SM <br /> HOME ze Q �����H/14 /\ �,E-MAIL /`�'��N L�' !�� Variance(# T670 ) <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> eVP1/j4-J �-,/f7i^4e0//. f ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDR of well/septic <br /> S <br /> 2 77 / .yyyf <br /> (City.State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE A q! IG 5'3'589' <br /> PHONE / ❑ Site Plan approval from <br /> ,0 57--2125--7:CF applicable township. <br /> E-MAIL ADDRESS E- ILAD R <br /> a�j ,..„.46c4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENTZONI G: ACREAGE ❑ Elevation of property <br /> ❑ PARCEL Or6 Q6/7 272_if-fr 0 lc j frontage drawn to scale. <br /> NUMBER // <br /> TOWNSHIP: SECTION: <br /> CI Driveway permits <br /> ADDRESS: / (state,county,town) <br /> CSM: 2,0c7 f7,-/' SUBDIVISION BLOCK/LOT CI Sanitary permits <br /> f2-2/ (public,private) <br /> PROPOSED PROJECT INFORMATION , <br /> PROJECT I ESCRIPTION: '` ' '" � <br /> • EX This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. } : .. )4 <br /> SANITARY SERVICE: ,r e s <br /> ❑SEWER it , s m g <br /> SEPTIC i '' <br /> HEIGHT IN FEET: if( NUMBER OF STORIES: (Not including basement) l <br /> 1i i 3'It <br /> AREA TO NEAREST SQUARE FOOT: ,• }4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - , , ` <br /> BASEMENT: 1ST FLOOR: .t7 ' , �_/el �, TOTAL SQUARE FOOTAGE: ,j , ":Z - �,-A,—' ,; <br /> 2ND FLOOR: 3RD FLOOR:� // ° -' £ <br /> �p <br /> V ' RY ,f ,t— <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ���� - µ; '' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gNo ❑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? CI Yes orNo <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) igYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes )4No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ --r. <br />