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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER rAME � IL <br /> "" ( `i\a S �k\ , ❑ Zoning Status;CUP; <br /> oWrtERARESS (Numbgr,Suet, o,State,zip) (� Deed Restriction;CSM <br /> ��((pp (('�Iflf 77 ICJ' y / Variance(# ) <br /> HOME PHONED CELL PHONE ( E-MAIL ADDRESS <br /> • SDI /y/ �° ���_ ✓ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> yt 1 £ 11 t t-k5011 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS i ,� (� of well/septic <br /> (City,State,Zip) ( Try State,Zip) Y� �I �_ I ❑ Setbacks <br /> 1i)C,V1Y 1,✓j 3.-3 r �j'? <br /> PHONE PHONE ❑ Site Plan approval from <br /> Cp 0S S-76'611'&5 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 11-0 q 08-33-9-9 y 3S A 4 fic.1..3, frontage drawn to scale. <br /> NUMBER <br /> TO SHIP: SECTION: <br /> a � Ski 1/: , 1/41/: 3 c ❑ Driveway permits <br /> AD Ess: (state,county,town) <br /> (.yd 7 J1°1 LOT PG SUBDIVISION ❑ Sanitary permits <br /> BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION - A!, � <br /> PROJECT DESCC�RIIPTION: : i <br /> �This project is a new building or structure. "z. <br /> ❑This project is an addition/alteration to an existing building or structure. - .' � <br /> SANITARY SERVICE: �, o <br /> �� PERMIT NUMBER: f <br /> ❑SEWER L3'SEPTIC t i <br /> HEIGHT N NUMBER OF STORIES: (Not including basement) <br /> t ® N x <br /> AREA TO NEAREST SQUARE FOOT: 4I : <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> 0 i t <br /> BA SJ 1 FLOOR: 37 �, '* <br /> y j TOTAL SQUARE FOOTAGE: j #;t:!9.11,77,.1%-iti <br /> '',,s,,�- n o-r <br /> 2ND FLOOR: 3RD FLOOR: %),/.." p �`Aeovr far �_/")SC� =� <br /> (f�� ,- - z <br /> ESTIMATED CONSTRUCTION COST: 01 8aav 4. .t. <br /> (Please round to nearest dollar) - ♦ - ♦ - <br /> I,. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes 6�J N� ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑,Yes ION CI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? !!fYes arc- <br /> 4. ❑NNo <br /> Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <br /> 5. Is this project associated with a rezone/CUP/variance(petition/ peal# e5 Y ) (leave blank if none)/ <br /> 6. Is a location survey required? (see reverse) / ❑Yes CI <br /> L�J Don't know <br /> 7. Is this to correct a violation? ❑Yes 13 1 <br /> o('®r Sc r; ice✓'s__, v...._ APPLICATION MUST BE SIGNED <br /> 4 545-112(4/08) <br /> ontinue on Back) ♦ -♦► -♦ <br /> 7a <br />