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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> TO -r �1'1p' ML 1L <br /> CGv. £z- C Zoning Status; CUP; <br /> OWNER ADDRESS (N ber, <br /> treet,City,State, ) Deed Restriction; CSM <br /> 7'b2 4) /- A a n.2 Yt"c c4 5.:s--Y1_ 6--II 5'7S7s' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60S 235 '22 t ,5 44`^e— ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME / <br /> TO Nc•-. 4; �� S /ra y l4 ❑Site Plan including location <br /> AGENT AUDRESS CONTRACTOR ADDRESS of well/septic <br /> 1113 t'<6 k ( ffil-k- - ?a2 A) /4' <br /> (City,SSttate,Zip), (Cit State, ip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> by Z.35 `t 2 2 b 6,0 5 -7 *7 1 sc(on applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL Z yfj frontage drawn to scale. <br /> NUMBER Ot O$-35 Ste-C �� <br /> TOWN HIP: SECTION: <br /> e rc)O G '/<: ,/4�/,: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 626, 2 Z Sk n S ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D $CRIPTLON : <br /> ❑ Zoning District <br /> . <br /> This project is new ilding 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 /> FIEWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ 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: ❑ ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> SO G , <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ 1 and available options. <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ ♦ 0Q <br /> t <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? 13Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Jlo <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) Eves v►/ o ❑Don't know <br /> 7. Is this to correct a violation? EYes !� o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />