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Z-? &if . <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW E <br /> 37/r oning Status;CUP;OWNER ADDRESS (Number,St yept,City,State,Zip <br /> Deed Restriction;CSM <br /> Q ? r/-7 !� I u°,--z_ 1)2 /4 (RCN G2) f Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS _ <br /> GP <br /> c93 1--lo ZS fv D-,?0—14 7g G‘'g r cd 4(/ e/ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> p ( r Cet I ac e.d 1 y Site Plan including location <br /> AGENT ADDRESS CO TOR DD SS f well/septic <br /> it. <br /> i¢-C4-,4 L.L 1 <br /> (City,State,Zip) (City,,-te,Zip) J etbacks <br /> - -Z/ k) ( r J Ck 7/ <br /> .5.37( k--� <br /> PHONE PHONE, �,� Site Plan approval from <br /> -; 9,/- (7.) 9-0 !� applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) [Elevation of property <br /> PARENT PARCEL MBER: CURRENTZO�{ING: ACREAGE: V` P P rty <br /> D PARCEL a/ / �f 0 /O/-7x775 J N_— ( 1 /2 `frontage drawn to scale. <br /> NUMBER iv // <br /> TOWNSHIP: SECTION: tith <br /> 7 , CA/,(J a-F 6 c)21re .1/4: '/a'/.: I '(•eway permits <br /> ADORES (state,county,town) <br /> 3 0 ? I), iK ''flU t". ' ) )lfh) (moo ) ki 3-37/lZ unitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> S E p G,,A's r (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: , �`' " <br /> r J 5 he-i) t � � <br /> LoZ X ( SG2C- <br /> • , l This project is a new building or structure. x,. g' 's <br /> ❑This project is an addition/alteration to an existing building or structure. ' ;� ..,1.1:7:-,..- <br /> SANITARY SERVICE: PERMIT NUMBER: �fjl <br /> :iorir ` z <br /> ❑SEWER SEPTIC f�" �J � ' ' � `3' <br /> HEIGHT IN FEET: j (6, NUMBER OF STORIES: (Not including basement) 6 <br /> AREA TO NEAREST SQUARE FOOT: _ �' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: t $ $. �w <br /> 4, TOTAL SQUARE FOOTAGE: ,, !, , �°` '' .3�, <br /> r <br /> 2ND FLOOR: 3RD FLOOR: / 4.-°- �- <br /> 3 57 „,�� "� <br /> ESTIMATED CONSTRUCTION COST: _" �� <br /> (Please round to nearest dollar) ♦ —• ♦ --► '♦ "♦ $ de , : $$ . , �• z <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 9ECNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 10 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 %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 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICA MUST SIGNED <br /> 545-112(4/08) (Continue on TION Back) BE—► —•► —0 <br />