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1,2-- , of <br /> ZONING PERMIT APPLICATION www.00ofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> IZ,, 4.4.. P. ,'P° ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip)/) , Deed Deed Restriction; CSM <br /> 3 of eehoh , s .84�7/�-r e`, Gam' _ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRES, <br /> AL 'SS13 T'7 - - +;iiTO -57f . ,.,,; ' lliz- ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ 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 /> PARCEL y frontage drawn to scale. <br /> NUMBER Lt f 1 cclkl5y!L Lrj l/y31 �'�eX ' J . �5� <br /> TOWN IP: SECTIO . <br /> y� pyL 2- 1A: 1/41/4; ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> �� "OK ��dB�y� �� .7. -s-- -/ ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ". <br /> lee,,zi, t ex j ,� -Alifere o en64sce� ❑ Zoning District <br /> . ❑This project is d new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address" <br /> FIEWER [EPTIC (new/existing) <br /> HEIGHT IN FEET ( NUMBER OF STORIES: (Not including basement) <br /> © ( � Li Wetland/Floodplain/ <br /> Shot-eland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimens 'ns including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: c t <br /> j, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access] '; .. <br /> “„ ,2ND FLOOR: 3RD FLOOR: a ( , <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦♦ ♦ 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? c 'es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eh es f No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? k es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Lives g2N o <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) ❑Yeslo ❑Don't know <br /> 7. Is this to correct a violation? Lives bNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />