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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> o f 5 try Gno% -14015+ PA#r►L k 4 011 ,Q <br /> OWNER ADDRESS (Number,Sheet,City,State Zip) i:4 Zoning Status;CUP; /�� <br /> 313 R etil ke, Avc. , 5100A.45 Grove , k'') i I , 5 31 14 Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-Z t S-ID 5q jessL.bey or )6 vh4;I•to,v, ,114 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 2� <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well MC <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks 2 0 <br /> PHONE PHONE 34Site Plan approval from 1/ k <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> j4 Floor plans to scale / �( <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) (� <br /> PARENT PARCEL NUMB R' CU RENTZONING: ACR GE: Elevation of property / <br /> ❑PARCEL JJJ l 2 v20—s? frontage drawn to scale <br /> .UMBER Del O^(/ / ��� 1 I �� <br /> /J 6 Q p 0� —S � '.'"°./ e— '/e: Al & '/.'/a: / h Z(rive ) <br /> ADDRESS: <br /> 313 44416 L. ; �M G.b.-t, , �.)S s37ly, <br /> 'n9 Xs-• permits <br /> CSM: LOT SU=`IZ/ISI `( BLOCK/L9 <br /> b <br /> L I blic ) <br /> PROPOSED PROJECT INFORMATION STAFF REVI „vs) <br /> PROJECT DESCRIPTION: f- l ► �� <br /> U v%Actc�"IQ G-Arc�e 12 x 72 Zoning District <br /> . ®This project is a new building or structure. 7,1 IX /2_ )C/ 2 f ,<permitted Use? <br /> ?6 t <br /> ❑This project is an addition/alteration to an existing building or structure. C el-kc-c) c-c CvA- <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Ad. - s <br /> EWER [EPTIC l (new/'42r <br /> HEIGHT IN Or / 2 NUMBER OF STORIES: (Not induding basement) <br /> 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: Z ErosionContr01 permit �� <br /> VI f n `z.(AS , TOTAL SQUARE FOOTAGE: j (slopes,disturbance, �V <br /> 2ND FLOOR:"► 3RD FLOOR: �� Z <br /> filling/access) �� <br /> N IA I <br /> Review Location Survey �/' <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ --► $ 3 p O and available options. / , <br /> (Please round to nearest dollar) $ U �j <br /> 7 �' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ©No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes air) ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes I 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) If Yes [go ❑Don't know <br /> 7. Is this to correct a violation? [Yes slo <br /> *no) <br /> 4 6 I if0 APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —. -► <br /> 545-112(4/08) <br />