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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 /> Li A-4-\c- ( 1-1 Ti 6_1((.C&- Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> !L'L-� ;+- H L �. cue T-� 17 w'1 -s-- �3 l variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3,L.-2 c ep-- t 6. 7 > H C/ S c r-r-4i- 61C ,4.4 C ci` <br /> n Site Plan drawn to scale <br /> AGENT INFORMATION I 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 Ti 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/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:07 -) frontage drawn to scale.PARCEL I _ V I —v e _Ct Z.44 _ t t `//NUMBER <br /> TOWNSHIP: SECTION: <br /> U;.v d O�� ' 14 1414 ❑ Driveway permits <br /> /7i�( is its <br /> ADDRESS: r� (state, county,town) <br /> /?/ (I p �-i L (/ G2 r 1/ I/v. ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: C-1 A I: �'1 C of (.I'L, , ❑ Zoning District <br /> 'this project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> fSEWER '�jSEPTIC (new/existing) <br /> HEIGHT IN FEET: CG'� NUMBER OF STORIES: (Not including basement) <br /> ❑ 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 /> TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> ''z <br /> Z 'Stir— 1 filling/access) <br /> 2ND FLOOR: 3RD FLOj <br /> 1, 2 612 5�e ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ $ (/??--(3 <br /> l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes KIN() ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No n Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑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) ❑Yes ENo nDon't know <br /> 7. Is this to correct a violation? ❑Yes pNo <br /> 1 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -1 -+ <br /> 545-112(4/08) <br />