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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 /> (p' I �i y ,t ❑Zoning Status; CUP; <br /> OWNER ADDRESS umber,Street,City,State,Zip) Deed Restriction;CSM <br /> 4-q4- - E I-L A.An JVp- /CIA a---rte`-'1.0 , � . Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 63o e-24,E -2485" ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ( 7 -LA 4-,V461/u L_ ( RA-La_ �;�/Q r�p�_. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> X34- / 1A-pc - AVE- . �,. AI,pY_ 4V� <br /> (City,State,Tip) (City,State,Zip) / c ❑Setbacks <br /> 1 -4 0�, \ , ��s3 7a4 ti,4-..0...7=5,0c)) Lk_ <br /> PHONE ! 1��– PHONE ❑Site Plan approval from <br /> 6,01 _ 25 ' -ea 6-7 Zoe —2.5,_ BPP.7- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 6,e,er-1`c_.o t,4_44,,u,C0Q _. �y (.,e n�vc�Ise✓p2L�-C' ,'?'J Floor plans to scale <br /> i.✓b _ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> 0 PARCEL �tss / frontage drawn to scale. <br /> NUMBER b/4- 08/[7 –352-®?28-te faA SAGE g <br /> TOWNSHIP: SECTION: <br /> 1/4: 1414; ❑Driveway permits <br /> ADDRESS: / VI (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT , ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> r e 4 i4-7. e. K A 6 , y 71-0,Q7Z,a1❑ Zoning District <br /> . ❑T.'s project is a new building or structure. ❑ Permitted Use? <br /> ES This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER $PTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: <br /> RIES: (Not including basement) <br /> 2 2._- <br /> ❑ Wetiand/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: $, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 7— filling/access) <br /> 2 C3 rT 2© 6 Fr ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q "'° and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ .35-0^0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes M o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y s ■,2 o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es Oslo <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 QVo !I I on't know <br /> 7. Is this to correct a violation? ❑Yes Vo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) –► - <br /> 545.112(4/08) <br />