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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> 7er-Z-- ttt-9 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME \ <br /> 1 SON S. -M10-Z6C'S ❑Zoning Status;CUP; <br /> OWNEIZADDRESS (Number,Stre t,City,S ate,Zip) J S3S f tC�� ,�/Jl� Deed Restriction;CSM <br /> q .()O 5Gi'1/t/P/aer 1 1 OI2C&T/', �� O'6� J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> A0 —3341'0-f W -71 6r/J 7:8 6mAt `Gosi 14 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,t� ��'�{//iflr- //At' Grit/!t!�- Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Da Setbacks <br /> PHONE PHONE p Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 51/Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: <br /> ,(�n CURRENT ZONING: ACREAGE: /(4/4'W,y/ � frontage drawn to scale. <br /> NUMBER I/�( I/`( 3 J Z,O,/ /�[' G-y <br /> TOWNSHIP: l ,I/�/ SECTION: r <br /> V/V/" / 1/4: 501 %ix,: �/ 0 Driveway permits <br /> ADDRESS: vzze ,......c..4/24,1�1� j� / � , i' ri f (state,county,town) <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> )f335 �J1 N0 4 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ■ 3t) 504A15C 41.06, e.1.‘ t, L401/(kRetv ❑ Zoning District <br /> . This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> V 0 FIEWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: - NUMBER OF STORIES: (Not including basement) <br /> Z6/ /// y� '`5,"3(9 1 . CI Wetland/F000dplain/ <br /> 1, ' ,v"n� AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1-1 ErosionControl permit <br /> At/ 47 s-, c , TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR! f filling/access) <br /> /V7 %✓9 rd `,79 Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --► $ r� ,.) and available options. <br /> (Please round to nearest dollar) ./cd l/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? JYes Do UDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes Rio QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes I�—jP,,�,o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? IYes ao <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le ue blank if none) <br /> 6. Is a location survey required? (see reverse) Pc 'es EINo ❑Don't know <br /> 7. Is this to correct a violation? EYes jNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />