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l <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 7.91- ! ER. ❑Zoning Status; CUP; <br /> OWNER ADDRESS (NytpberStreet, ty,State,Zip) .f Q/L �/ ro Deed Restriction; CSM <br /> 36... 9 �1 t tai_ v rf� ��/'/ / �� J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3 it 7 • '5 �PcJ 5 ct wit- 0., R e_c{d e /-6,' c kt a r+ c Y- n 4 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ri-N L/�16 P C/L Slue-- 2/,1/c— 5/G,.iS' hic ❑Site Plan including location <br /> AGEN ADDRESS CONTRACTOR ADDRESS of well/septic-77) e_g-6"---k eAle-s CT <br /> (City,State,Zip) (City State,Zip) ❑Setbacks <br /> M4— iJD0 i1/ s37/7 <br /> PHONE PHONE ❑Site Plan approval from <br /> 3731-06'49( applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ,�/,, ciesi h .5/ti,( ^Mi€ I Cs❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> r)3 <br /> PARENT PARCE NUMBER: CURRENT ZONING: ACREAGE: <br /> ®PARCEL 2 07 ogx3o3 9ho A -1 33 � T Y0 frontage drawn to scale. <br /> NUMBER 7 <br /> TOWNSHIP: SECTION: <br /> /Y1 1b j:. LeT 7 0 /1J1 Z0 %: % : ❑ Driveway permits <br /> ADDRESS (state,county,town) <br /> 380 7 �I,_1,e-_ 3t-LL IoP- b CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> P Et) - 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: n <br /> 5 ` -,cj,, i-Gt • t 1 R--e (rQ ,,,1 ,--(.. LI Zoning District <br /> MThis 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 /> EWER [EPTIC 13 - k© I q - 00 3 .5'7 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3o . 0 a LI Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> f' �'C 4b '2 i Co ,2,-/- -z) 7 L/ c 3 j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> bance, <br /> 2ND FLOOR: 3RD FL OOR, filling/access) <br /> S ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION)COST: ♦ ♦ ♦ ♦ -► ♦ z / O 3 and available options. <br /> (Please round to nearest dollar) J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑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? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? fYes .EINo <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) Dyes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ — <br />