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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 /> jo� S/ ���06._ El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /(/1 -F/ cI cu-)i <br /> 2.3641 CO UA)' 4 L� 5 Deed Restriction; CSM <br /> 5 5J� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AD �C- <br /> DRESS <br /> /I U352-CR65 - -3i) 1 she vrl 6I7e iCo, .f")e RSite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME A4. uC S <br /> `a9 1-4-,j kit Ck G1&0 se. C-0 Sa.kS Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 23q 2 eovki ry Ra AB 1Go(o w Q-1 t_1 f')E t <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> A4e-fAL /J w" I 53-5 t„i ND‘ 531 t 3 <br /> PHONE PHONE <br /> � �- 3�-�/ Site Plan approval from <br /> (o og 222_. t r2.14 6 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Shy''/L red-COrrX. YC f in,. c G co El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.diane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL tr 10 -,4.i -5321 - <br /> NUMBER 12_5 , 2.4 2_ frontage drawn to scale. <br /> TOWNSHIP: 1)U Ai 1/SECTIO <br /> 1/4: '/4'/a: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2382 Gool;T y r-DAD qg A-1c-rwec_A-1 D , \A) i 5355g <br /> CSM: LOT SUBDIVISION , BLOCK/LOT ❑ Sanitary permits <br /> II ore.voL5 Z (public,private) <br /> .1_ <br /> PROPOSED PROJECT INFORMATION "STArt ' .<� <br /> PROJECT DESCRIPTION: .LL7 4 77 <br /> DES ova_ Cu/& 73r CokfCiPx1E- PAT-10 U District 4. <br /> l <br /> • ❑This project is a new building or structure. <br /> Kt This project is an addition/alteration to an existing building or structure. $ se <br /> SANITARY SERVICE: PERMIT NUMBER: i <br /> z <br /> [SEWER SEPTIC OneVP t ' Y <br /> HEIGHT IN FEET: �� i NUMBER OF STORIES: (Not including basement) <br /> • Ei r*WIF‘attinff' ? <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: / 1ST FLOOR: / } • <br /> 4, TOTAL SQUARE FOOTAGE: j -��s• +)� <br /> r <br /> 2ND FLOOR: 3RD FLOOR: /f rVIL 7 ) <br /> ESTIMATED CONSTRUCTION COST: <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? '®Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ®Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? E Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes E 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 g No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes IKI No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />