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ZONING PERMIT APPLICATION Www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME ► ( CUSTOMER TO PROVIDE <br /> 5-0 k,"\ 44- kafer, k 1..E+ r <br /> f i I <br /> Zoning ` <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ng Status; CUP; �/ <br /> 1(�L}+-} Q�. M Deed Restriction; CSM <br /> ut-rt < < <∎ . 1 c`(51-\ toa 3 59 Variance(# C� <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ) / <br /> ICeog (Q[1 -av5c2 <br /> AGENT INFORMATION CONTRACTOR INFORMATION 0 Site Plan drawn to scale <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAME �C <br /> AGENTADDRESS FZ. Site • cluding locatio 4. 4. <br /> CONTRACTOR ADDRESS O <br /> (City,State,Zip) (City,State,Zip) / 3/'3 <br /> ,Setbacks (v (04 <br /> PHONE PHONE ,I2 Site Plan approval from N� <br /> applicable township. <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS <br /> )12 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wl-us/) <br /> DPARENT PARCEL NUMBER: CURB N ZONIN ACREAGE: a Elevation of property <br /> NUMBER V"1 t O�_q5 a S50 H Pr i 21 C/ rontage drawn to scale. <br /> TOWNSHIP: �[ SECTION: 1 J �J _ <br /> O Y '\ 2� '/<; NW '/a' Driveway per • <br /> ADDRESS p (state, county <br /> 223 Sttir1 cPrci, `\- Rct Wc�-ct'(uc 1„)3. 5'J3�1-{ <br /> CSM: LOT SUBDIVISION KSanita ih.••� - <br /> BLOCK/LOT <br /> (public privat- <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: / STAFF REVIEW <br /> p�-S` '\ \p cx r_ 1 Y 0 e /0 0 /X Z L p/ Zoning District A 7g�� <br /> • giThis project is a new building or structure. A J01r // / 1 <br /> This project is additio / eration town existing building or structure. t Permitted Use? /�p(pf� <br /> SANITARY SERVICE: / ��C <br /> PERMIT NUMBER: Rural S0�G/ <br /> FIEWER SEPTIC (new existing 43 HEIGHT IN FEET rr rr NUMBER OF STORIE (Not incl ding basement) ,��+ <br /> 1 l O - 1_ ° e,e-S4- t bk.ff) , ' - •a loodplain/ <br /> AREA TO NEAREST SQUARE FOOT: �orela d ►attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ArErosionControl permit 7b <br /> 2 000 ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) /�,P�o <br /> at- <br /> ESTIMATED CONSTRUCTION COST: Review Location Survey <br /> (Please round to nearest dollar) -+ —► ♦ —► —► ♦ aS (� and available options. �,� <br /> 1 , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes ONo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes ONo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? OYes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes 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) Dyes No DDon't know <br /> 7. Is this to correct a violation? OYesNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► -+ <br />