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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> '� //,�/AA L/,�/ 0/94‘ l/11,4-/ ❑Zoning us;CUP; <br /> OWNER ADDRESS NumberStreet,City,State,Zi <br /> /t� ScnCIC r Ii p/3C/% 'b /4i' 3f'�� De estriction;CSM <br /> Variance(# ) <br /> HOME CELL PHONE E-MAIL ADDRESSD <br /> 0 y � /n'R , i. 7i'0 ,er • `a rh ❑Site Plan Ow/11W scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and inclucMs dimensions <br /> AGENT NAME CONTRACTOR/NAME J <br /> f)�`vF G 454.ifIc- ,/q,o,e i, QU,/,� , .S ❑Site!,Pla cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of Weirseptic <br /> /098 /�fh,ry , ' /vBg ,-/e"eyA/ <br /> (Cif State,Zip) (QV.,state,Zip) ❑Setbacks CL <br /> PHONE PHONE ❑Site Plan -p �, .I from <br /> G oQ- ?Sr- a/3/ 06, �.3S"'a /3/ applicab ' .I�(- ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,(4... c' C rrc Acal, e.ve S7' vE ,4'.ft'l/Fie / <br /> 6,6. ‘0,4, ❑Floor plans scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevati0 ofpfoperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El N MBER O5o ',22-3-8600 -3 Pe.: frontage W.wn to scale. <br /> TOWNSHIP: SECTION: <br /> ,DO/)ivo St /1 GV '/a: S bo %I : ❑Drivew rmits <br /> ADDRESS: (state,county,town) <br /> 7C M: LOT SUBDIVISION BLOCK/LOT ❑Sanitary pvate S <br /> (public,orate) <br /> .affsi t n!S d/ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION. <br /> &,) j4 oa ❑ Zoning District <br /> . 2fhis 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 /> EWER l EPTIC /2 -,2d/r-6006 q V (new/existing) <br /> HEIGHT IN FEET: ' / NUMBER OF STORIES: (Not including basement) <br /> kr 1 Yv 1 ❑ Wetl nd/ plain/ <br /> REA TO NEAREST SQUARE FOOT: <br /> Sho chment) <br /> (Outside dimensions including nfinished area,attached garages and above grade decks or porches) <br /> ❑ Erosi•nC,` ••I permit <br /> BASEMENT: r 1ST FLOOR:� �� r i�•.ance, <br /> /73 7 'rive_e / ez." {�"�� TOTAL SQUARE FOOTAGE: + (sio, .,d <br /> 1 Y ` «/ ^ filling/ac as <br /> L4 I 6 <br /> 2ND FLOOR: 3RD ooR: C6J� <br /> ❑ Rev w -j:tion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ a3v� Q�'l an a I : • e options. <br /> (Please round to nearest dollar) vV <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes Elo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes aii ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [/ fes do <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [vo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) ❑Yes to (Don't know <br /> 7. Is this to correct a violation? [Yes DKo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aioe) (Continue on Back) ■ —► <br />