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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 /> Y,✓/CE LLWGg C T Prc ig/V ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City, ate,Zip) <br /> g � o0/lLYA/ tVz— 570 A/ al/ ,;35 6 Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 69s 30ZZ- ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,PL /i '✓&may /4bgn/B''Z(g L T onf ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> / s, 737I RO/SO)d 239 <br /> (City,State,Zip) //,,,, (City,State,Zip) z/2. ❑Setbacks <br /> £077 za 535 Coz7r ba L�%? li`L .� 1 <br /> PHONE PHONE ❑Site Plan approval from <br /> S -e=v-IdS 5-93"-- 4 /o applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> G/.7/ ' a /• GD M-- - G 01/•p 110/ Gar.-- ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ElPARCEL /p_z-47i-9295--S /f_43 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> lNN 25 '/4: SS '/4'/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> Sz6-1. &;2Ot t yit/ v,u5 t7 7'J <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits - <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION _ STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 6 ��jf A/ / /3/— ' ❑ 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. 1, <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET ,, NUMBER OF STORIES: (Not including basement) <br /> //;0/1 / ❑ 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 r-1ST FLOOR: "- ❑ ErosionControl permit <br /> /62_[L 4 TOTAL SQUARE FOOTAGE ,j, (slopes,disturbance, <br /> COT filling/access) <br /> 2ND FLOOR: 3RD FLOOR: // ,i <br /> (O ,Jy§ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ ����, and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ '♦ --► •♦ �P <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? likes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes ffNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [ Yes \lo <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) Ekes QNo ['Don't know <br /> 7. Is this to correct a violation? [Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► — -► <br /> 545-112(4/08) <br />