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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> 1 .29 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> -To E L. -'N. E E 14kN K_c Ining Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> (p2i DAi�3 Er l T SI -MA .- Da o>4. iNt 5353-S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADt�RESS <br /> s • .• p II [�Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A ENT NAME CO TRACTOR NAME <br /> N1D-t v._ 4 S 1 b I+T Cu<'roM kt es 1,4 C-C Er Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 27.4) Agri s- . V.6 , tax I a <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> baS ■ , W s 51-S 6tnl;.asz t, V3'M "53 S S <br /> PHONE PHONE ,[Site Plan approval from <br /> 212_-LZ -c applicable township. <br /> E-MAIL ADDRESS E- AIL ADDRESS <br /> Si J T()40W-A�Mc-S ?6,4411, Floor plans to scale <br /> PROPERTYILOCATION INFORMATION (http://accessdane.co.dane.wi.us/) [�E evation of property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: <br /> 0 NUPARCMBEL ER O 5n ( °3 ?OM L al y 1 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> • 61 E 6 A Driveway permits <br /> �ko /.: S'W /a/4: state,county,town) <br /> ADDRESS: <br /> (pZ 1 W S■ PA i L_ Sanitary 1 its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publi private) <br /> CN 0"11-S <br /> PROPOSED PROJECT INFORMATION STAF • EW <br /> PROD CT DESCRIPTION: <br /> 1\00%Z 1 %J T;, 64 S-rt nit„ 3est beut-E. ZZ ing District <br /> . OThis project is a new building or structure. l`J Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' a'..-r <br /> EWER ,IkEPTIC `3 -Z( t L-` 00 4-z.4 (new =xisting) <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement) 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 /> ErosionControl permit <br /> BASEMENT: 1ST FLOOR: j TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> S. Z S i Z filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ‘ Z 4 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ,,� ♦ d� S r O�� and available options. <br /> (Please round to nearest dollar) �P <br /> / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies a o QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes 4 o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes II o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes E o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le ve blank if none) <br /> 6. Is a location survey required? (see reverse) es U■,o [Don't know <br /> 7. Is this to correct a violation? ///QYes '!� o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -+ <br /> 545-112(4/08) / <br />