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ZONING PERMIT APPLICATION Www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWN R NAME // CUSTOMER TO PROVIDE <br /> OWNG''ef r/ ' !�"4-e Get'/ `--� <br /> OWNER ADDRESS (Number Street,C/ ry <br /> t Zi ' Zonin Status CUP�r� > Zoning CUP; <br /> 5-J / 2 (o/1&�cic 1-4, j'Az/s-,r /�j S 7 7 Deed Restriction; CSM <br /> HOME PHONE Y � G .� / Variance #CELL PHONE /t MAILADDRES ( ) <br /> 6• ,_2/ 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION <br /> AG NAME and includes dimensions <br /> �^ CONTRACTOR NA J <br /> 7C/--e6- � C { / r . 4 toe--7` <br /> e` 5�//t?/hr 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRES <br /> 15/r. C �/ s�. 3/ of well/septic <br /> R,t,State, iP) / ( Y,State,Zip) ` �� <br /> .--74-c�G✓�S7S���i m ,,/ �t � -3 S�i! Setbacks <br /> PHONE <br /> _ PHONE ❑Site Plan approval from <br /> �' d g- S-7 S --3T cp�‘, & dg- - 5 ,7J —3 p,E 7 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -P 1,-F". <br /> I f, Ij .�j t , t co--* ❑Floor plans to scale <br /> FROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> 0 PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> PARCEL <br /> NUMBER 0 7 a filY93yo6a / a 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: / 1' <br /> �fl 41? h /,; /%. ❑Driveway permits <br /> ADDRESS: (state, county,town) <br /> 77 3 y G✓, 04/.Ssz, / I.// w/ <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: r <br /> � <br /> 1 X/I FIC'c7 2 4,,Q',#.J; '7 Li Zoning District <br /> ❑This project is a new building or structure. �' <br /> 0 Perm tied Use? <br /> NThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: D Rural Address <br /> EWER AEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ' - <br /> f S• S I El WetlandFloodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore]and {attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Ej Erosioncpntrolpermit <br /> "--,5;2, j TOTAL SQUARE FOOTAGE: j slopes,giltsturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ESTIMATED CONSTRUCTION COST: ��Y L i Review Location Survey <br /> (Please round to nearest dollar) ♦ --1. '� -II- -► -11. (� �[� and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes No QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ( Yes 01Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYeso <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) QYes 01,,lo QDon't know <br /> 7. Is this to correct a violation? QYes to <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -s -* <br />