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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 /> . D(1 ‘1,c_. :Zoning Status; CUP; <br /> OWN RADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> act 11 'Bus;nets %s.V. bt. erls Pc:4,,rr4,WL &4481 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> I, '—IZ b;11.._4rt■ '• ibn trrG•rc 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> r r%\Vre- '�AIt:OC nce +A'br+ "The. Sa nocAs droop 1,r,c_ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 21o4 hie ?lei-thine guly 311 grvnr cla\ NAIAN, bid r3cr <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> Illar:V.Son WI 53113 V,awsoak.)l VII S44Q1 <br /> PHONE PHONE Site Plan approval from <br /> (715 $i a-xaaa applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> D Flo plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dtane.wi.us0 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> El PARCEL <br /> � <br /> N UMBER 0101 � 3 Ka) 0 C frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Mack•`SDr1 . 4- ,/,/4; N Driveway permits <br /> ADDRESS: <br /> (state, county,town) <br /> ?<k)1 W. tell I'ne 4W Y, Mao►zn,r,.lAtr 3371 :S ' permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> public, rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,� � <br /> 'ter i -i1-,e. gm-rer Arinerlcp r1 Ill 3AppLo Nce. 66-e t.9'Zoning District <br /> . ❑This project is a new building or structure. (�, tO4.L El <br /> ki■It). ' �^ -�� L�3 Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: <br /> PERMIT NUMBER: ❑ Rural Addre. S <br /> FEWER f)EPTIC r>j0. (new/e 'sting <br /> rHEIGHT IN FEET: ' NUMBER OF STORIES: (Not including basement) <br /> � <br /> 4 _ (�4 2 Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> 1 Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: EI OSIOnCOntr01 permit <br /> 152, iO'?- SP , TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> Off/ +2 S� / filling/access) <br /> — 1G8, 596 SF <br /> C�1 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ —4. ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ A‘auF1 1 310.E <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes :No 510on't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes DJo '2Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ��},`,o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes :No �c] Po.i 4-Kn,J <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 o ['Don't know <br /> 7. Is this to correct a violation? :Yes o <br /> 1 t APPLICATION MUST BE SIGNED <br /> 545-112 aroa V (Continue on Back) -► -+ -♦ <br /> t ) <br />