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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME ,/J //'' C STONER TO PROVIDE A .- Z <br /> OWti ADDRESS Number,tl. (rat t S) 6.11 Zoning Status;CUP; Z V <br /> t meet City,state,Zip) 9 / 1 / <br /> 19ok _ '�r,, d&rty � a [�ra c c3 1 sect Restriction;CSM ( ll <br /> HOME PHONE CELL PHO E E-MAIL ADDRESS/ 3 Variance(# ) <br /> 0 - = -11(9 c .0. 06-57Oa b. 19S-) @ Pel,,vdl.Gam t 12/S'ite Plan drawn to scale A C <br /> - <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAME <br /> AGENT ADDRESS di r !. ' • . 4 � a Site Plan including location <br /> CO -ACTOR A 0 t•ESS of well/septic <br /> W6o►� Gfy EE j <br /> (City,State,ZIP, G 3/; V So/c0 <br /> ( te,ZIP) Setbacks <br /> PHONE r wvtllL/ (,Jr c3/VI <br /> PHONE 114-ite Plan approval from <br /> E-MAIL ADDRESS nO - �'4ci•✓A- n, ,,(,4M is)) pplicable township. �4 <br /> E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) 3 2-PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property 3 <br /> NUMBER oi8/0511-In -91(00.0 A-X 19.16 frontage drawn to scale. <br /> TOWNSHIP: /' SECTION: <br /> CO a5 e-isro+� 11 '/.:T 7 N %%: A 1l E Driveway perm <br /> ADDRESS: (state,county own <br /> 1O10T ,c4-rac■Abrrry a Ate, <br /> CSM: �� LOT t� SUBDIVISION BLOCK/LOT 1LY Sanitary Remits <br /> �— (publi ovate <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW o / <br /> 2_() <br /> PROJECT DESCRIPTION: <br /> • • ' Aid 4, ! S rcc � <br /> _/, 01Zoning Dist'ct <br /> EIThis project is- ne uI ( or structure. <br /> This project is an addition/alteration�s to an existing building or structure. <br /> y Permitted Use/ c',1--0- / <br /> SANITARY SERVICE: 'y..,,�> PERMIT NUMBER: X RuralA s <br /> EWER J�SEPTIC I \(heW/3 3]iL• <br /> HEIGHT IN FEET: j Y\ NUMBER OF STORIES: (Not inducing basement) - <br /> AREA TO NEAREST SQUARE FOOT: �iiYirul' ant) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ry"�' ,,- �/� <br /> BASEMENT 1ST FLOOR' - o (sopesnControl permit S l^"--p <br /> Zj` -oo +TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access)filling/access) C F <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: Review Location Survey <br /> (Please round to nearest dollar) $ )'‘2, c00 available options. ! IF 1 <br /> 1.The property is within 300 feet of a stream or 1000 feet from a pond or lake? IYes UVo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es L No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? yes Olo <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) QYes �1 o []Don't know <br /> 7. Is this to correct a violation? DYes + o <br /> APPLICATION MUST BE SIGNED <br /> 6161+2( I (Continue on Back) <br />