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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 /> ASS Z%%., cv4,N7vcs \r...a,¢^rit.,c-- C4 ta•N.Cti■■ %.t'\ 0 Zoning Status;CUP; <br /> 4e NERADDRESS (Number.Street,City.State,Zip) Deed Restriction;CSM <br /> �(� `t to wFYf VI %-t. �kw1._ UlT■ 11 03 td»cMv 1.T.L 663 1 Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 3 49. ALa.-I3.z.' )+i - ,4.Swt , n U..1 C14%. ,c. D Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME V H ( Gr.� <br /> � )%v-A"n .1 %C-vk; VS toot 1... oL.cts 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> S4 Lt F (co Q.% h.)-Q._ SIR40341as-- \Si) ,-S 71,s$5414 V <br /> (City,State,Zip) 1_ (City,State,Zip) D Setbacks <br /> PHONE � 't1 ~r- Si go 2 PHONE 4 L 4 1 SS.` ❑Site Plan approval from <br /> LI,H_,S.w e- 64■L 4 7.,3 _�--e 6-- S 9tf 5— applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> e , EJ Floor plans to scale <br /> PROPERTYILOCATION INFORMATION (http:'laccessdane.co.dane.wi.usl) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El <br /> 0PARCEL ��� ;^ frontage drawn to scale. <br /> NUMBER �>, 1/�49 332-42.41 U <br /> TOWNSHIP: SECTION: <br /> �- 1/4: 1/4%4: D Driveway permits <br /> "'y (state,county,town) <br /> ADDRESS: <br /> ;?. L 0 C. <br /> - 11.V.VC-VSc y. C.T . ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRO E T DESCRIPTION: <br /> PRO <br /> * I/i d� ��ljl rr ❑ Zoning District <br /> I2This proje s 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 /> DEWER DEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF,STORIES: (Not including basement) <br /> I ❑ Wetland/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: l�1 r It ,---, ErosionControl permit <br /> I( 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: //qS c. c 4• ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ t o 0 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes E 4o DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes alo DDon't know <br /> 3. Have you talked ���7 your project and are they in agreement? f: Yes [;Vo <br /> 4. Has there been I'It�it for this property in the past 5 years? Dyes f -,'No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# t° . - ti) (leave blank if none) <br /> 6. Is a location survey perire �(sri9everse)V' -�Wk'r <br /> ' Dyes Elio DDon't know <br /> 7. Is this to correct a violation l' DYes DNo <br /> VM COUNTY PLANNING&D.:E.L1 i3L, APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545112(4/08) <br />