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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 /> c`�- 1 1/71 , q//�'i.74,-)-7.6 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) - Deed Restriction; CSM <br /> Li//7s- 0<-: 5 Variance(# ) <br /> HOME PHONE CELL PHONE i E-MAIL ADDRESS <br /> (5.0t Y.? .' 7`r S" `,e v s-C 73 sy Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> :Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) i(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/) Elevation of property <br /> PARENT PARCEL N�MBER: CUR NT Z ING: ACREAGE: <br /> Li NUMBER I�'^a/ 56/6J�U7J i/ b.-J/ — �f 7 frontage drawn to scale. <br /> TOWNSHIP: / SECTION: 6 <br /> v 4,? :1/4: ,/4,/' :Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1/7-S" Oak 5.7' <br /> CSM: I LOT / I SUBDIVISION . !BLOCK/LOT E Sanitary permits <br /> 7b ,S „,-/.., /7 //s <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: � � <br /> ❑This project is a new building or structure. P`� rr <br /> � �l�ted Use�'g <br /> ZThis project is an addition/alteration to an existing building or structure. ,',':,', , <br /> SANITARY SERVICE: PERMIT NUMBER. ' 0 Rural Address `, <br /> EWER r)EPTIC (newlexisft-tit/Y.:,' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /_57 / 0 , tlan Flood latr� <br /> 1Nelland! <br /> I ...... _ _..........._...__ .................__. Sh chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) z3 3 <br /> BASEMENT: 1ST FLOOR: <br /> Q LEroslonObnrl rmit <br /> ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR — I iilllntOdpess) <br /> __— Z 8 J' 0 <br /> lRev L to Suve <br /> ESTIMATED CONSTRUCTION COST: , ;and aaila on . °(Please round to nearest dollar) --I 'r -♦ 'r "r 'r $ /S c...c'° <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes ONo :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'? :Yes Elio <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes ZNo <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 /> 7. Is this to correct a violation? :Yes ZNo <br /> APPLICATION MUST BE SIGNED <br /> 545„Z 14/08) (Continue on Back) --r —r -0 <br />