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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE i�
<br /> O NER NAME-
<br /> 0.V \d VA ors--may er Zoning Status;CUP; /
<br /> OWNER ADDRESS
<br /> (Number,Street,City,State,Zip) eed
<br /> Restriction;CSM -Z sic,e,
<br /> To W e r Ln t G . rnu rS\\& ' , 113‘ 5- 6p Variance )
<br /> HOME PHONE CELL PHONE p E-MAIL ADD ESS (� j,,, }�
<br /> •0.- •5 -.)10 , (11i► 1' cr+tlifm 3t 'i-Cru 9 Site Plan drawn to scale ,EZ....„
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME C TRA TOR NAM /�,.
<br /> \c � ()l So n Site -,::.-= ding locatio ,,`
<br /> AGENT ADDRESS CONTRACTOR ADDRESS O ' ell/sept,
<br /> ._3 5 P ccti( 1'e ,f-. r-7 A/2510ka
<br /> (City,State,Zip) (City,State,Zip) Setbacks 6,3
<br /> PHONE PHNE Gf�AQ�,W, gSite Plan approval from ./
<br /> U0 D--DiR_ I2Sb applicable township. Q�4-
<br /> E-MAIL ADDRESS E-MAIL ADDRESS q
<br /> ro S6r' )30 C-" whoa•Can't 7I Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (h ttp://accessdane.co.dane.wi.us/) Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACRE GE: P P '`7
<br /> ❑PARCEL og(a—a c3--bob-9 Pt- 1 EX Lp rontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP:,�/� SECTION:
<br /> 1 fie&nc,_ a(, 1/4:_. ,i_ . 5C t� riveway permit
<br /> ADDRESS: (state,county
<br /> 5051 Towel'lane_tZA MtLfS‘na,q, 631 53 C.1,9
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public '
<br /> (public a'
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJEC�g ESCRIPTION' t\ XZoning k<e-\jVA\GV -e06C IN �jCNC� (C -) e C- District A -'/ �K
<br /> . ❑This project is a new building or structure. ( v\, GA-� ,S�' a 5��� permitted Use? fj,�
<br /> 'This project is an addition/alteration to an existing building or structure. C o �Q�/� F
<br /> SANITARY SERVICE: PERMIT NUMBER: TV /'Gl� Rural '-
<br /> rEWER ' EPTIC (ne isting)
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> 1 , WeUand/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: ^ es,disturbance,t r permit fif
<br /> j TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, v v
<br /> 2ND FLOOR: 3RD FLOOR: DA^
<br /> filling/access) ,(�/(r
<br /> (/b Review Location Survve"y��, `
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ S 'o O,O� and available options. ,-
<br /> (Please round to nearest dollar) �p
<br /> I
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ININo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? es ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 'Yes ❑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 �No ❑Don't know
<br /> ['Yes 7. Is this to correct a violation? Yes No
<br /> _PPLICATION MUST BE SIGNED
<br /> 545-112 ialoa> Cantinue on Back) -• -+
<br /> $ 6e, 6 0
<br />
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