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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 /> ?O k S. K OAS S Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Co 3 ci (A C ovrl ty JooLC/ 4 ;3.Q(/ '/// Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6 oe S76, -/IZ(o r Vass. € J'►o1#4 A'f ce.••. Q ite P drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S.te P including location <br /> GENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip (City,State, CICS <br /> PHONE PHON ❑ Site I proval from <br /> a Icabl ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Fl o ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dtane.wi.us/) E evatio f property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Er <br /> ❑ NUM ER 0 y 0 - 05'0 S -/q 2-e010-3 /) / (6-10 / p -7- f n e drawn to scale. <br /> TOWNSHIP: SECTION: <br /> IM,o bek iv'U S C Drivew mits <br /> y '/°: iv w '/4'/° N (stat o ty,town) <br /> ADDRESS: t <br /> lv`) i"J 14M1'C to '1�-e.tle-olle_ Sanita •ermits��i/ <br /> CSM: ris SUBDIVISION BLOCK/LOT <br /> (publ ,priva - <br /> PROPOSED PROJECT INFO!4MATi:`' c 9TAF l""rEW <br /> PROJECT DESCRIPTION: <br /> L _.10/c** .1 (a S 6 e_d �-�0 X 9 Q 110- onin 1 istrict <br /> . ethis project is a new building or structure. ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural A..r � <br /> (SEWER SEPTIC /_V/ (new -xisting) <br /> HEIGHT IN FEET: ) NUMBER OF S RI S: Not including basement) <br /> „� �0 ` V wetland/F000dplain n ', <br /> A‘13 Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) osio o of permit <br /> BASEMENT: 1ST FLOOR: t aUrbanCe, <br /> j, TOTAL SQUARE FOOTAGE: j (slopes,eS, <br /> 314 O Q filling!." es. <br /> 2ND FLOOR: 3RD FLOOR: <br /> iew Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 30/ bd and available optio s. <br /> (Please round to nearest dollar) (- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 1 Yes ❑Don't know° <br /> 2. Is there a wetland or floodplain on or near the property? 'es ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? arg ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes p1VO <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 E No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [ go <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 <br /> 545-112(4/08) <br />