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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App F <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWME <br /> ��tb 'P4 ❑Zoning Status; CUP; <br /> OWNER ADD (Number,Street City,State.Zip) Deed Restriction; CSM <br /> 5 AIL.�V[ND ,o., Veg.•=4,3p, �35g3 Variance(# ) <br /> HOME PHONE c CELL PHONE E-MAIL ADDRESS <br /> 2.15019 5I ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT ME Q CONTRACTOR NAME <br /> MP Le YE S l.LC- 4 4 M� ❑Site Plan including location <br /> AGE A DRE_S CONTRACTOR ADDS of well/septic <br /> (City, ate Zip) t� � � ��� � (City, State.Zip) El Setbacks <br /> A <br /> PHONE A` PHONE ❑Site Plan approval from <br /> 1-s f /D applicable township. <br /> E-MAILADD ESS E-MAIL ADDRESS <br /> Tx _ e Tem 1-411M11-17* G orw ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (hftp://accossdano.co.ciono.wLus/) <br /> PARENT PARCEL NUMBER CURRENT ZONING: ACREAGE ❑Elevation of property <br /> ❑PARCEL 7+` i ��I 3�{ 56F0.- frontage drawn to scale. <br /> NUMBER '> Tt/ 0��ZdiV /� - 1 7 <br /> TOWNSHIP SECTI <br /> .M I Mt10 vA ,A: iq‘A %IA: N 1ij ❑Driveway permits <br /> ADDRESS--1 j (state,county,town) <br /> T Z�c9 L e, ' L 3 �r ❑Sanitary permits <br /> CSM LOT SUBDIVISION BLOCK/LOT <br /> • G r NDs (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D W RIPTION:�llfil <br /> e (-C■10 it 44 el ❑ Zoning District <br /> This project is a new building or structure. <br /> CI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ Rural Address <br /> DEWER XPTIC [ �. 2014- 0041 D (new/existing) <br /> HEIGHT IN T- ■ '-F NUMBER OF ST .IES (Not including basement) <br /> /v .-0 ��/' ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR ❑ Erosion Control permit <br /> 24 So &1 S + TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2 Any 4l �trIN F <br /> ? S t • <br /> 10 2,tt (.54 <br /> .�� U Review Location Survey <br /> ESTIMATED CONSTRUCTION <br /> ION CosT: ♦ -0 ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) ‘00 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves ►:INo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves n o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? d Yes /No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes )16o <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 No ❑Don't know <br /> 7. Is this to correct a violation? Des No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) <br /> (Continue on Back) ■ -0 <br />