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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> v�N n ADDRESS °L U P `, e- ) p Zoning Status;CUP; <br /> O ER ADDRESS (Number, t,CI State,Zip) } Deed Restriction;CSM <br /> /6 9/ Tin,/-0- ACrTiff T, 41 n ria• 1)6 Lt,J, S, 535 0 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS n�1 <br /> -0 - , 3 - 7'7X G i - /"- 1. r d An-lief, re ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE 1:1 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p ❑Elevation of property <br /> ❑ UMB <br /> NER acjj)- ),2,Z - 0 E, c,1- 5 A I , 7 3 �; frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ,C� -J / J a Y.: %14: y E El Driveway permits <br /> e ' (state,county,town) <br /> ADDRESS: �- / <br /> 67'/ 74'41 - D-,..5A r, Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> O ' I <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Gar c e -6,,- To�;';.? (:1 ` ❑ Zoning District <br /> . <br /> This project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER JEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 S 1 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionCOntrOl permit <br /> BASEMENT: 1ST FLOOR: <br /> 9 /C.+ 4 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> / C 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ ♦ ♦ @ 1 D �,� ,� and available options. <br /> (Please round to nearest dollar) $ j <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres Oslo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes n o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres CI o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes a. <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) Efres ! o ❑Don't know <br /> 7. Is this to correct a violation? :Yes 6 o <br /> APPLICATION MUST BE SIGNED <br /> It <br /> 545-112(4/08) <br /> Z 7/46, (Continue on Back) -► -, -r <br />