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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N . <br /> � C+j-- rrell l€ O Zoning tatu • UP; <br /> OWN <br /> IV R ADDRESS SS�( Street,City,State Zi ) Deed R ction; CSM <br /> (Number, <br /> oe#2/ �� Variance(# ) <br /> 'HOM PHONE EL HONE -MAIL ADDRESS <br /> l(/ i t6 v .,,/ 'Cc2, ' "' ' OP■ Le , ':,J O Site Plan drawn t scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ mensions <br /> AGENT NAME CONTRACTOR NAME <br /> O Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) [Setbacks <br /> PHONE PHONE 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: CUR ENT ZONING: ACREAGE: ` <br /> ❑PARCEL t��/C - KA, gn v-S � levation of property C <br /> -_ � frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 041C-6 ,/4. ,/4,/4: Driveway per••' - 4 <br /> AD SS: (state, coun y,town) <br /> DR L'G3 Wee, c_ M Aci/SON Sei7/ Sanity - -: • <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (publi., private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> C DANA rt/i Gil 1 CoNA-k-fty , ;e_. (Io0af, Ir/ (a.y ❑ Zon strict <br /> This project is a new building or structure. (\O �. v�a� ❑ Permitted Use? ���� <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PTIC (new/ex• tl ) <br /> HEIGHT IN FEET: J r NUMBER OF STORIES: (Not including basement) <br /> .JJf��,�� / I /I Cl Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1—, ErosionControl permit <br /> • <br /> 3Z 00 + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3 ❑ Review Location Survey 5tzle <br /> ESTIMATED CONSTRUCTION COST: �7� • and available options. rea- <br /> (Please round to nearest dollar) '♦ '♦ ♦ ♦ ♦ ♦ .00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes N] o ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes No ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres ' ∎,,o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i none) <br /> Z <br /> 6. Is a location survey required? (see reverse) Yes ONo ODon't know <br /> 7. Is this to correct a violation? QYeso <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -i -- <br /> 545-112(4/08) <br />