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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> ?A / —Ido4S , <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / „— <br /> KU r� I' - 3y s1-a L :/ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 479s CIA- t wc.,A Lo\10 & Su/I P2A-,a-■..L. . i S1S-41O Variance(# ) <br /> HOME PHONE I ELL PHONE E-MAIL ADDRESS <br /> ••d mss- L.7 te4 VG Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME Cs <br /> Site Plan including Iocatio <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic ���y�� <br /> S <br /> (City,State,Zip) (City,State,Zip) Setbacks 3 0(//"4 6 <br /> PHONE PHONE Z Site Plan approval from, t <br /> applicable township. C <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> a Floor plans to scale <br /> /i <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) , Elevation of property <br /> ❑PARCNUMBER /c//'-'NUMBERZ --9 %_VCURRENTZONING: ACREAGE: <br /> EL � 33►7/ /41 -/6-_-,‹ frontage drawn to sc <br /> TOWNSHIP: SECTIO <br /> S to p r 3 '/4: w El %1/4: Driveway permits <br /> ADDRESS: (state, county, <br /> 4 r <br /> CSM: LOT SUBDIVISION BLOCK/LOT [Sanitary per "ts <br /> v �p Z �___ (public, Nate <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECTp SCf 10 f:1 r D e .e.______ A,-/c. (eC--- aZoning District A -1k-it <br /> . <br /> This project is a new •uilding or structure. id-Permitted Use? ceie <br /> .This project is an :dditi•'/alteration to an existing building or structure. 4/11, <br /> SANITARY SERVICE: ,�q PERMIT NUMBER: AS Rural Ad•- <br /> �EWER h( �EPTIC (new/ • <br /> HEIGHT IN FEET: \ NUMBER OF STORIES: (Not including basement) <br /> '1--- ) Ad'Wetland/Floodplain/ , i <br /> Shoreland (attachment) Ay <br /> AREA TO NEAREST SQUARE FOOT: 4. <br /> r <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErosionCantrol permit <br /> BASEMENT: 1ST FLOOR: t1 D 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, 4C f <br /> 2ND FLOOR: 3RD FLOOR: 7 filling/access) 6 ,e ) <br /> 2_ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: A Oa /1O and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ U (/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ❑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'? Dies ❑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 ENO ❑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 />