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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM }— ( Z <br /> 11 rcc'*' ` c� � \0 C..) ©Zoning Status;CUP; c. el <br /> OWNER ADDRESS (Numb Street,City State,Zip) <br /> \ 1it �\{ Deed Restriction; CSM•r iN ���R� 1 () V \A.C1��1 , 1J J' 54--C - Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> C) • Z--I• 122 115. . " I. 't\I t 11 ' a . ci. ( ('1 ` .nel- [I Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions' ' <br /> AGENT NAME ^ CONTRACTOR NAME C 09/„ <br /> `, (1 —VC' f t'11J�11 �� �VI,ICh J tC'(1r Site Plan including locatio K/ <br /> AGENT ADDRESS �, CONTRACTOR ADDRE ^ ftc , <br /> 1V) S 7\7 ,i \l e -\f .' 129_-) J. X 7 1\ve? 1 1 <br /> (City,State,Zip) (City,State,Zip) d Setbacks 3 oh), to <br /> 'vvvv, -Ck , v\ i L-IIuU o v�1 u u , w 1 x 0 ■ <br /> PHONE PHONE Site Plan approval from ' 4 <br /> —},GJ .`5,47,-O5G►� ',�• y"J• <br /> ��"JV C applicable township. ,u <br /> E- AIL ADDRESS_. E-MAIL ADDRESS <br /> 1 a 1,1 t I' r - A v. 0.? 1 S)&n. Conn Et Floor plans to scale l q <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) '03 Elevation of property �S /� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL Z do j 0 -1 1 U(,1 frontage drawn to scale. <br /> NUMBER r.3' f o1�- 3 C—2 <br /> TOWNSHIP: SECTION; <br /> MOO I Srt -j� / // Driveway perm' <br /> 1" Y� 1 �4. �4�4. <br /> ADDRESS state, county, war <br /> NC —11401—i w r t- it ? \Avv ` iA\S`1'i,V i �JJ113 to .- • =ry permits <br /> CSM: LOT SUB (VISION BLOCK/LOT .ubl ,private) <br /> to 1 _ 3u 3 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW / <br /> PROJECT DESCRI�ION: +'� G3�/ � 'F/ Zoning District <br /> G-- , 4 L <br /> i wf .� (ncuIc�finf , 0 3 0(-7- 3-- <br /> _L 3 <br /> . DThis project iVa new building or structure. Sd IN l F/CV lA Wet 11 E 1'S ►^ Permitted Use? et ' i <br /> .This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: (ural A-4• <br /> R(. <br /> HEIGHT IN FE <br /> EWER FIEPTIC (new "' <br /> NUMBER OF STORIES: (Not including basement) / <br /> , t , ,�„� 3 -� I Wetland/Floodplain/ ) <br /> �-� horeland (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 /> BASEMEN 1STFL00R: I ©�; iN j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ,E 1 <br /> N l N I I lJ rl., Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -r \Qy r,���� ��/ and available options. ! <br /> (Please round to nearest dollar) <br /> 1 I�, (�lV <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes (� <br /> Q No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? OYes •No cpon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des .12 o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ( Yes END <br /> 5. Is this project associated with a rezone/CUP/variande (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Eyes CE1No ODon't know <br /> 7. Is this to correct a violation? Des ao <br /> .. _, _.. ..„ <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />