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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE l <br /> OWNER NAME ^ 7" <br /> MA rt N 051-0 in Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM , <br /> 3 & G U-. 1/46 4 col-1.46e G+roc,.Q._ Eva S55 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> bog.3-3,,i C.'7 I ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �._R ❑Site Plan including location <br /> AGENT ADDRESS t: `` '" ` --�. , "' _ <br /> CONTRACTOR ADDRESS of well/septic `3 / / <br /> (City,State,Zip) (City,State,Zip) , - ^ 1 4 Setbacks C 3/3 a/" o <br /> JAN 5 2015 CO/)r <br /> PHONE PHONE Site Plan approval fr m <br /> applicable township. <br /> E-MAILADDRESS E-MAIL Atjti'REtS`'"" "1';.' '" . i—:i <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT P RCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL Li I d ra 3-11-2.1-29/3o-0 �N' 9 1 8, 3 cI frontage drawn to scale. <br /> NUMBER r <br /> TOWNSHIP: SECTION , / <br /> TOWN of Coll ; �\). Z� '/e: w '/e%<: �Driveway perm, - <br /> ADDRESS: (state,county owe <br /> 38 Vo viLRS i� <br /> Sanitary p- II's <br /> CSM:^ 9-O LCT I LOT SUBDIVISION BLOCK/LOT (public, • <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION:612' L S}A 6 D /'0 n 6 r4, `C AYI Zoning District If <br /> . OThis project is a new building or structure. permitted Use 22 r / <br /> This project is an addition/alteration to an existing building or structure. /'i'f' a? <br /> SANITARY SERVICE: PERMIT NUMBER: At Rural Ac.' s S <br /> EWER OEPTIC (new/. • <br /> HEIGHT IN FEET +- NUMBER OF STORIES: (Not including basement) <br /> �� 1 ice• oodplain/ <br /> oreta (aichment) coo <br /> AREA TO NEAREST SQUARE FOOT: fp <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ((lV <br /> BASEMENT: 1ST FLOOR:. EroSIOnCOntro.permit <br /> I014 O s j, TOTAL SQUARE FOOTAGE: j (Slopes,disturbance, ■ <br /> 2ND FLOOR: 3RD FLOOR: i filling/accts) 4_,f10 �j <br /> 10 osr <br /> / D� Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: @ and available options. /a'— <br /> (Please round to nearest dollar) ♦ ♦ ♦ "� ♦ ♦ $ I ©d , — <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes aro (Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y-s PI lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ►�1 es / o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Alo <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 )2'O ❑Don't know <br /> 7. Is this to correct a violation? )4es �Vo <br /> APP MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ♦ -•► -0 <br /> ( ) <br />