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, <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> use 0 Zoning Status;CUP; <br /> OWNER ADD ESS (Nu reef,City,State,Zip) <br /> • <br /> `g i�u Deed Restriction;CSM <br /> S-rll val� N8 �Ln ei-a., - e..J (..A. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS .53S 40 <br /> to ; L . ' <br /> • ca` ,, - £ 10" • meet i • AAir 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> A <Ill'V,-S mt d"fit U it) iU s c/i S S ,v c;, a•e-f ,j ❑Site Plan including location <br /> �vrRACTOR ADDRESS of well/septic <br /> 13 ELtl'S' ti '. 6 vJ t a:-d rd ?)Q /ec 't- d v, <br /> (City, te,zip) (City,State,Zip) ❑Setbacks <br /> PHONE ei 3.-3s-9 G HONE ❑Site Plan approval from <br /> ( -(.j ciii-Li 7q 7 �� (� — ?Li�'—190 a applicable township. <br /> E-MAIL ADDRESS ii E-MAILADDRESS <br /> • // ' h vsJ a•l, 0 y'o u,a,y�i r • ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) a cp <br /> 0 PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> PARCEL frontage drawn to scale. <br /> NUMBER 0 1 a kW-4'o C1' A Sti g <br /> TOWNSHIP:0c 81 og SE ON: <br /> 9'-o _ /4: �L✓ 1�4 1�4. St,./ Driveway permits <br /> si-vrJ ray.-� (state,county,town)A RESS: �.3rd/ 2 7 O ti I e./`d gV vJ T rl..•rt, t T ❑Sanitary permits cs LOT SUBDIVISION BLOCK/COT <br /> V`1/` (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> -'h ¢"`'Y SP-5 it) S'v 6 4, (pi, ,y,) 3)ev fli a n t4,14_ ❑ Zoning District <br /> • QThis project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. ❑ Permitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> LI Wetland/Floodplain/ <br /> 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 /> 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> 6.7.-4,S1 4I !o filling/access) <br /> id # 6-� / ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ` 3 7 and available options. <br /> (Please round to nearest dollar) "■ 'i '► -► -■ -► <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? laes [ L ld" QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [fYes [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? L__ 'Jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies ONo <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) S R know <br /> 7. Is this to correct a violation? QYes <br /> APPLICATION MUST BE SIGNED <br /> 545-121''08> (Continue On Back) -► -� -� <br />