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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App X
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NiME
<br /> L...MAA "2- t\\Z) .,'{q (>..,t' rl S V\`G.l). t.R„, LLL 0 Zoning Status; CUP;
<br /> C ''-'=R ADDRESS (Number,Street,City,State.Zip)
<br /> itck'g g h c<& , \_ � 0.k�� WI 535 9 "I Deed Restriction; CSM
<br /> _ "-'� �N � J 1 Variance(# )
<br /> I,,.not PHONE CELL PHONE E-MAIL ADDRESS
<br /> l6'32; 235-- (t,o$)Z35—5s3 .1 1c...V -Y Lao ,3 .i•• Cdr-\ 0 Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME I CONTRACTOR NAME
<br /> is L.0._v. ex, e,,,e 1 '2►,r 1 c.\ii\ Ab r o S. 0 Site Plan including location
<br /> AGENT ADDRESS ;CONTRACTOR ADDRESS of well/septic
<br /> s. $2:. t'`t\ ec * * goo a rtc c\ Ka
<br /> (City.State.Zipj 1(City,State,Zip)
<br /> Setbacks
<br /> w.x..Y R.� 1 53P7 We,,5 -.S0Aerr, , S 4664
<br /> PHONE i PHONE 1 ❑Site Plan approval from
<br /> L l o o S 1 1) Z35 ^ 'S 5 3 C. 1 (<.,4 0.3") 7 3(.0, -0 8 9 0 applicable township.
<br /> E-MAIL AD RESS I E-MAIL ADDRESS
<br /> \cL..�.• (s,F.$% * tea\..Cbft\ i V't y,t,W .\fl 4 ckc! 6roS. u,,,n 0 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http J/accessdane.co.dane.wi.us/) Elevation of property
<br /> PARENT PARCEL NUMBER: I CURRENT ZONING: I ACREAGE:
<br /> C
<br /> PARCEL ,,7 %y�, r , , I frontage drawn to scale.
<br /> NUMBER . ti, `1 .
<br /> TOWNSHIP
<br /> sECTlov .;.....1, i
<br /> y . j/ ,e-( (t/ Al 4 Y., ,/,/. El Driveway permits
<br /> .!, s �. 7 4 ✓ 4, 4 4.
<br /> ADDRESS
<br /> (state, county,town)
<br /> ❑
<br /> CSM LOT TS-UBD.VISION BLOCKJLOT Sanitary permits
<br /> 1 i (public, private)
<br /> I
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION.
<br /> f i-.:,! v is� ' ❑ Zoning District
<br /> ❑This 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 /> ,~ ,p � neWl @X1Stin
<br /> (—EWER EPT1C (new/existing)
<br /> HEIGHT IN FEET: , NUMBER OF STORIES: (Not including basement)
<br /> ❑ WetlandlFloodplain/
<br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment)
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> —
<br /> ❑ ErosionControl permit
<br /> BASEMENT: I t ST FOOR:
<br /> f 4, TOTAL SQUARE FOOTAGE: i (slopes ds yrbance,
<br /> I i— filling/i b
<br /> 2ND FLOOR- j 3RD FLOOR:
<br /> —__---_._......__.__ ❑ Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST: —I. and available options.
<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? Des EN. EDon't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes a. QDon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? [ (es DINo
<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) QYes No QDon't know
<br /> 7. Is this to correct a violation? jDYes Divo
<br /> APPLICATION MUST BE SIGNED
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