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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY' WNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE12 E <br /> MOn A. s6 — ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,C tat Zip) Deed Restriction;CSM <br /> HOME-1 ONE Ili 1 i C`E+L�L PHONE bil_v_t O A- L S� Variance(# ) <br /> a 1E-MAIL ADDRESS•t O,A '0 j 2_ 3 •l b■$52_'7 1 Z-I Y'n MC LQ C' 'YV\C 4E" Cal ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I RECsgtvEr) <br /> tion <br /> AGENT AD DRESS CONTRACTOR ADDRESS <br /> (City.State,Zip) 1(City,State,Zip) - A �u <br /> — . t) <br /> PHONE PHONE ❑ JUN �Site Plan approval from i <br /> applicable township. <br /> ��7�p.�..y.+�r� _coo- <br /> - <br /> E-MAIL ADDRESS E-MAIL ADDRESS EtCIEvao""'p.4 VrAigg Irl errs cale <br /> PROPERTY/LOCA ION IN ORMATION Z6ttp J/accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCE NUMBER: CURRENT ZONING: • ACREAGE: <br /> ❑NUMBER O6S�O `(0 ^2�3-0557-0 • . 34)271. frontage drawn to scale. <br /> TOWNSHIP:,. {(� 1 SECTION <br /> K l� L ► i— 1_ I/o: K3� 1/a'/a: 3' ❑Drivewc •- - <br /> ADDRESS: ry �r •- (state,county,town) <br /> 0 2"10 l 5 g( G� L ' ❑Sanitary permits <br /> CSM: LOT / SUBDIVISION BLOCK/LOT <br /> (�C, (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION $ <br /> U/ , 4 C c �, _( le(,(, f C J _ ❑ Zoning District <br /> . Et his project is a new building or structure. J ❑ Permitted Use? <br /> II This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVI : PERMIT NUMBER: ❑ Rural Address, <br /> EWER rEPTIC (new/existing) <br /> HEIGHT IN F T f %t NUMBER OF STORIES: (Not including basement) <br /> `Q I _ ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area atta ed garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ' I ❑ ErOSIOnCOntrO)permit <br /> Lt 1 TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> Review Locatiomsurvey, ,,: <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? ElYes INNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? FIYes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es FIND <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es [ No -OO1i— et a)el <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) rfres EfiNo ❑Don't know <br /> 7. Is this to correct a violation? Elves Ian o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aioa) (Continue on Back) -0 -0 -0 <br />