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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY COWER INFORMATION C STONER TO PROVIDE <br /> OWf NA <br /> ow E DR ` �&7tvs1 7 ' e/leaky C ►J Loning Status; CUP; <br /> ESS (N mber,StreLi ate,Zip) <br /> j/� d+ 2 P W,v,4 eed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3/e .9.3o gr'9�" NU /1/�62■ ite Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION n includes dimensions <br /> AGENT NAME CONT CTOR NAM <br /> /valve 56z 6-7-- Si e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> (City,State,Zip) (City,State,Zip) Se backs <br /> PHONE PHONE ite Plan <br /> proval from <br /> p lic a township. <br /> E-MAIL ADDRESS E-MAIL ADDRE S <br /> /t f 6 A/ N loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/ <br /> PARENT PARCEL NVMBERi CURRENT ZONING: ACREAGE: Elevation of property <br /> 0 NUMBER coo A51-B 5©a /?g 5 , y frontage drawn to scale. <br /> TOWNSHIPS,r -© SECT N: �I <br /> V �'eo �� 1/4: N , , ('J ❑ Driveway rmits <br /> ADDRE (state unty,town)ceeND <br /> CSM: LOT SUB IVISION BLOCK/LOT - ID S- It .-rmits <br /> O,ti� (. • ic, . ivate) <br /> PROPOSED PROJECT INFORMATION ST F REVIEW <br /> PROJECT DESCRIPTION: /1 <br /> LeiTA/ ./e) 4 A C�(/2S?ec1‹. s© ya o • Zo • g District <br /> • ViThis project is a new building or structure. ❑ permitted e9 <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER. ❑ Rural • ."• - s <br /> V <br /> FIEWER PEPTIC / O Aj e (ne e isting) <br /> I/ <br /> HEIGHT IN FEET: /3 ( NUMBER/F STORIES: (Not including basement) <br /> UN-5 u e I ❑ Wetlan oodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shor and (attach nt) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: /) ' 1 1ST FLOOR: ❑ ErosionCo of permit <br /> A 0/V N: 0 /t.I ,l TOTAL SQUARE FOOTAGE: , (slope isturbance, <br /> GOO; fillip access) <br /> 2ND FLOOR:N'a� 3RD FLOOfjy O r. <br /> fvi /\/ ❑ Review Location Survey iI4:ka <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �i 0 and and available options. <br /> (Please round to nearest dollar) o! <br /> ( C ccb N�i?g:.j4s>--} 412 Na � &v-to --**G t ' ci 021 4; as , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes JRNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes j!1 o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? res 7No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ['No `? <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) es �No ['Don't know <br /> 7. Is this to correct a violation? ,Yes ['No <br /> 4 / 9. 0 ‘ <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ ♦ —► <br />