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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 /> a°14-11/41 f D A- e CQ R( FL-P/N ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 10443 SLI 1CL(PPG RO 6(.4-c4 ga2N vj 1 53 S i S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> L,Oa 777- 23gi 577-7 23 <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AG <br /> JIVE 01 A4. etvsr. SIEVE 014e4 Co",sr. f Desk4v ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> -7(o42 (.t it oss G. eo t u9e- (e Q.os SE l <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Ctzoss PLA-I,..r, s GO 1 5352i9 CLIZT'Ss RA4 PS W t S3s z: <br /> PHONE PHONE ❑ Site Plan approval from <br /> co ut) - 235-02.87 (fir,_ 9 Spa S applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: LI Elevation of property <br /> Li PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> e %1/4: ❑ Driveway permits <br /> �' "'L" l=A KT1-� A: (state,county,t <br /> ADDRESS: ( own) <br /> 10 4 q 3 S41'cc,P PIC R9 13 J CK- EACTH •`'' ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: �� ,1- � <br /> i 4f- Ik OI.D No uSe (3Low NP.J� fJcwst ' _ � � <br /> 0-This project is a new building or structure. ' <br /> ❑This project is an addition/alteration to an existing building or structure. _ ° ' "'' lAr''' <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> CO <br /> ❑SEWER ❑SEPTIC „ ° . <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) . <br /> ;a e ��s� <br /> .k� : fie !°.'S��, <br /> AREA TO NEAREST SQUARE FOOT: 7 t <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,<,:_ '` ° t? <br /> BASEMENT: 1ST FLOOR: ,, W <br /> 'fie <br /> t t _ o 114 j TOTAL SQUARE FOOTAGE: ,, ®` - N '-- <br /> fghli 2ND F�LOdOR: 3RD FLOOR: ' � <br /> V a 7ym <br /> SD ESTIMATED CONSTRUCTION COST: �i- <br /> (Please round to nearest dollar) "'0- Z(l Q� 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,9 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 ,O,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 j;:rNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► —► <br /> 545-112(4/08) <br />