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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> 6040644". VVatenigArr / Ati t eittdeVr , (-LC <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status; CUP; <br /> ZZZ 1J0["5' LTQ , '7 Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MaL,ADS Variance(# ) <br /> i , .24.5•d1 1�� . d0ue O t•rL� <br /> AGENT INFORMATION CONTRACTOR INFORMATION ❑Site Plan drawn to scale <br /> AGENT NAME and includes dimensions <br /> C�t� CONTRACTOR NAME <br /> AGENT ADDRESS it t~ ��t� ❑Site Plan including location <br /> CONTFtACRADDRES� P <br /> SiCl1p -r C.r, Z TC2 of well/septic <br /> (City,State,Zip) <br /> (City,State,Zip) ❑Setbacks <br /> WAV/JAVZIN ;,547 rlG1i13ve/i 1 t/r 53-711 PHONE <br /> PHONE ❑Site Plan approval from <br /> WS.. 355 •I q 1 S. e" , Si(. ibir 7 applicable township. <br /> E-MAIL ADP RESS <br /> E-MAIL ADDRESS <br /> SAW'0 r `o'k— s+' .cfts, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> 0 PARCEL PARENT PARCEL M�ByER:d 1.� CURRENT ZONING: ACREAGE: J Elevation of property <br /> NUM ER 26 i � 1 1' 32`�L�1�s frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 1/,; /4�/: E]Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> ¶-""`r- &on4n•44:a1/ CV`&IOC ❑ Zoning District <br /> igThis project is aztew.building or structure. (•fCwgiip,ra,• ) <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER r)EPTIC .(flew/existing) <br /> HEIGHT IN FEET: 1 NUMBER OF STORIES: (Not including basement) <br /> D0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ESTIMATED CONSTRUCTION COST: ❑ Review Location Survey' <br /> (Please round to nearest dollar) ■ -♦ -► -► ♦ and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes JNo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres p1 o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes I, o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? aes ONo <br /> 5. Is this project associated with a.rezope/CUP/variance(petition/appeal# ).;-Illeave blitiq' ) ', <br /> 6. Is a location survey required? (see reverse) 0 I "o' • <br /> Yes ❑No QDon't know <br /> 7. Is this to correct a violation? L Yes ONo <br /> APPLICATION MU BE SIGNED <br /> 545-112(4/08) (Continue on Back)ST --0 <br />