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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 /> 6 t' i t'L S Rs°`'skr— ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> t997O /./0.43 Eta /'✓E.- , ,<7I 01r=s'0-1. h!- - Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6'BPi " 99s-$a ea ',el -Kt;„) d-, . Ask. ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /yGS2 ,Jvh+Js or-I //ovf e D;xfa tf ❑Site Plan including location <br /> AGErrffrr ADDRESS CONTRACTOR ADDRESS of well/septic <br /> iV9a't /?1vtZ go Ng 041 M 2�� tza <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Pby i Pby� ''E ,-,,z <br /> PHONE PHONE ❑Site Plan approval from <br /> e2 y — (7 's••"7- Fre 0 G(.,' Try •- P r6 0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> I4 ► -, Mu el:wrensriCi Cow iit,4.+1a4 (.1"h.-pcxnt friivton ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PA NURMCEL BER GAY/PE/U"JS'y�;? _ 3 . 0 frontage drawn to scale. <br /> .�� <br /> TOWNSHIP. <br /> D4)44 PJ SECTION C/O}N:/ <br /> S ,/: ,/4,/: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 77P N R.■:32 r- Pro — ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> )c c3 L 3 • l i (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> T'r� t - /NE") ( & -ç Lv cry oc■f ❑ 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: ❑ RuralAddreSS <br /> EWER nEPTIC (new/oust ing) <br /> HEIGHT IN FE T: NUMBER OF STORIES: (Not including basement) <br /> it)g Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Erosion Cont of permit <br /> BASEMENT: 1ST FLOOR: ✓ 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> I , a 1 a a, /80 fang/access) <br /> 2ND FLOOR: 3RD FLOOR: ! ( O <br /> �S '/ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: �-,,�-�r� and available <br /> (Please round to nearest dollar) ♦ ♦ ♦ "'. ♦ ♦ �� COO <br /> options. <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 2: o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres U o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes 2lo <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) 5fres ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ViNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► --1. -+ <br />